[Synergistic divergence--case report]

This 12-year old girl was diagnosed with congenital exotropia (XT) on left eye (OS) when she was 16 month-old and she was subjected to five surgical interventions on OS. She is now with face turn to the right. Visual acuity is 1 cc. Anterior segment is normal on right eye (OD) and multiple scars under bulbar conjunctiva are present on OS. Posterior segment is normal on both eyes. Ocular motility: at cover-test XT is present on OS in primary position measuring 60 PD at distance and near (and left hypertropia) which decreases at 40 on levoversion but increases at over 80 PD on dextroversion. Ductions: OS abolished adduction, limitation of depression, OD normal. Versions: in dextroversion OD abduction is associated with OS abduction. Binocular single vision is absent. Surgery has been done on both eyes (large recessions on lateral recti). Postoperatively orthotropia was present in primary position with persisting simultaneous abduction, but the patient and family are very satisfied about the esthetic aspect.