Related Experiment Video
Updated: Apr 1, 2026
Surgical Correction for Pediatric Epiblepharon and Trichiasis
Published on: July 8, 2025
Long-term Cosmetic Alignment Following Surgery for Esotropia Versus Exotropia in Childhood: A Comparison Using
Insights
Surgical outcomes for childhood esotropia and exotropia were compared. Success rates were higher for esotropia, with fewer patients requiring a second surgery for this condition.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus Surgery
Background:
- Long-term outcomes for childhood esotropia and exotropia surgery are documented.
- Direct comparative studies between these two common strabismus types are lacking.
Purpose of the Study:
- To directly compare the long-term surgical outcomes of childhood esotropia and exotropia.
- To evaluate success rates and need for reoperation in pediatric horizontal strabismus.
Main Methods:
- Retrospective review of children under 18 undergoing horizontal strabismus surgery (2000-2012).
- Exclusion criteria included structural eye pathology, severe vision loss, neurological disorders, and complex deviations.
- Failure defined as a second surgery or deviation >20 prism diopters (PD) post-operatively.
Main Results:
- Overall success: 78% for esotropia, 65% for exotropia.
- Reoperation rates: 12% for esotropia, 18% for exotropia.
- Mean final deviation: 9 PD (esotropia) vs. 10 PD (exotropia); survival analysis favored esotropia (P=.008).
Conclusions:
- Children with esotropia demonstrated a higher likelihood of surgical success based on survival analysis.
- Many transient deviations above the 20 PD threshold were not clinically significant.
- Long-term outcomes were generally favorable for both conditions, with only 14% requiring reoperation.
Purpose:
Although long-term results following repair of esotropia and exotropia in childhood have been reported, the two entities have never been directly compared.
Methods:
Records of all children younger than 18 years who underwent horizontal strabismus surgery from 2000 through 2012 were reviewed. Children with structural eye pathology, severe vision loss, neurologic disorders, and incomitant or combined horizontal and vertical deviations were excluded. Failure was defined by a second horizontal surgery or a primary position deviation greater than 20 prism diopters (PD) at any time during follow-up (as long as 10 years). A threshold of 20 PD was chosen because families often consider deviations important enough to warrant a first or second surgery if it is larger but not if it is smaller.
Results:
Of 317 children, 235 with esotropia had surgery at a mean age of 42 months and 82 with exotropia had surgery at a mean age of 60 months. Overall, surgery was successful in 78% of those with esotropia and 65% of those with exotropia. A second surgery was performed in 29 (12%) of those with esotropia and 15 (18%) of those with exotropia. The mean deviation at last follow-up, using absolute values, was 9 PD for esotropia and 10 PD for exotropia. Survival curve success was better for esotropia (P = .008).
Conclusion:
By survival curve analysis, success was more likely among children with esotropia. Many "failures" slipped beyond the 20 PD threshold only transiently and had deviations that were not noticeable to family or friends. Overall, children did reasonably well long-term following surgery for both esotropia and exotropia. Only 14% of the entire group required a second surgery during an average of 41 months of follow-up.
