Related Experiment Video
Updated: May 19, 2026
Surgical Correction for Pediatric Epiblepharon and Trichiasis
Published on: July 8, 2025
Surgical intervention in childhood intermittent exotropia: current practice and clinical outcomes from an
Deborah Buck1, Christine J Powell, John J Sloper
1Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK. deborah.buck@ncl.ac.uk
Insights
Surgical outcomes for intermittent exotropia (X(T)) in children showed one-third excellent results, but a significant 37% poor outcome rate and 15% persistent over-correction. Further research, including randomized controlled trials, is needed.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Strabismus Surgery
Background:
- Intermittent exotropia (X(T)) is a common form of strabismus in children.
- Surgical intervention is a primary treatment for X(T).
- Understanding surgical outcomes and factors influencing them is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate surgical outcomes in children with intermittent exotropia (X(T)).
- To identify relationships between preoperative/surgical characteristics and outcomes.
- To assess rates of satisfactory control and over-correction post-surgery.
Main Methods:
- Retrospective review of 87 children (<11 years) undergoing X(T) surgery across 18 UK centers.
- Primary outcome: motor/sensory results (angle, stereoacuity).
- Secondary outcome: Newcastle Control Score (NCS) for satisfactory control.
Main Results:
- 35% excellent, 28% fair, 37% poor primary outcome; no influence of preoperative/surgical factors.
- 65% achieved satisfactory control; 20% had X(T) recurrence/persistence.
- 15% experienced persistent over-correction; no link to surgical dose or preoperative factors.
Conclusions:
- While two-thirds achieved satisfactory control, 37% poor outcomes and 15% persistent over-correction are concerning.
- Surgical dose did not correlate with under- or over-correction, suggesting over-corrections may be unavoidable with current techniques.
- Randomized controlled trials are needed to further investigate X(T) surgical outcomes and management strategies.
Purpose:
To describe surgical outcomes in intermittent exotropia (X(T)), and to relate these to preoperative and surgical characteristics.
Methods:
87 children (aged <11 years) underwent surgery in 18 UK centres; review data (mean 21 months post-surgery) were available for 72. The primary outcome measure was motor/sensory outcome (angle and stereoacuity). The secondary outcome measure was satisfactory control assessed by Newcastle Control Score (NCS).
Results:
35% of patients had excellent, 28% had fair and 37% had poor primary outcome. Preoperative and surgical characteristics did not influence primary outcome. Satisfactory control was achieved in 65% of patients, while X(T) remained/recurred in 20%. Persistent over-correction occurred in 15% of children. There was no relationship between over-correction and preoperative characteristics or surgical dose/type. Median angle improved by 12 prism dioptres (PD) at near and 19 PD at distance (p<0.001). Median NCS improved by 5 (p<0.001). 40% of those initially over-corrected remained so by last postoperative assessment; no relationship was found between an initial over-correction and good outcome.
Conclusions:
Whilst excellent motor/sensory outcome was achieved in one-third and satisfactory control in two-thirds of patients, the 37% poor outcome and 15% persistent over-correction rate is of concern. Surgical dose was similar in those under- and over-corrected, suggesting that over-corrections cannot be avoided merely by getting the dosage right: a randomised controlled trial (RCT) would shed light on this issue. Initial over-correction did not improve the chance of a good outcome, supporting the growing literature on this topic and further highlighting the need for randomised controlled trials of X(T) surgery.
Related Concept Videos
01:27Open Angle Glaucoma: Treatment
Drugs such as carbonic anhydrase inhibitors, α2- and...
01:28Angle Closure Glaucoma: Treatment
01:26Esophageal Strictures-II: Clinical Features and Management
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...