Intermittent exotropia: continued controversies and current management

Continued controversy exists regarding intermittent exotropia and its management. Although it has been studied extensively, the indication for and timing of intervention and what therapy is most efficacious remains unclear. This article reviews the most recent research and the controversies surrounding the disease classification and treatment options in the management of intermittent exotropia.

Current studies are underway to uncover the natural history of the intermittent exotropia. Patching and observation are reasonable treatment options in the first 6 months of the disease presentation. As the disease progresses and nonsurgical management fails, botulinum toxin may play a role or be an alternative option in the early treatment of intermittent exotropia. Surgical treatment with orthoptic therapy may result in improved postoperative outcomes.

Although significant investigations have been performed on this entity, there remains poor cohesiveness between clinical trials resulting in lack of clarity regarding when and how to treat intermittent exotropia. As the natural history of the disease is elucidated and researchers standardize their assessment of the control of the strabismus and what constitutes a successful treatment outcome, better understanding may occur to develop more efficacious remedies. Despite being less known and utilized, botulinum toxin and orthoptic therapy are options for treatment for intermittent exotropia and should be considered for appropriate patient's treatment protocol.