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Updated: Jan 6, 2026
Surgical Correction for Pediatric Epiblepharon and Trichiasis
Published on: July 8, 2025
Factors Associated with the Prognosis after Operation in Children with Recurrent Intermittent Exotropia
Ji Ah Kim1,2, Young Suk Yu1,3, Seong Joon Kim1,4
1Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.
Insights
Peripheral suppression impacts surgical success for recurrent intermittent exotropia in children. Targeting immediate overcorrection may improve outcomes for this common childhood eye condition.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus Surgery
Background:
- Recurrent intermittent exotropia (X[T]) presents a significant challenge in pediatric eye care.
- Understanding factors influencing surgical outcomes is crucial for improving patient prognosis.
Purpose of the Study:
- To identify key factors affecting the success rate of surgical correction for recurrent intermittent exotropia in children.
- To establish predictors for favorable outcomes after reoperation for X[T].
Main Methods:
- A retrospective review of 50 pediatric patients undergoing surgery for recurrent X[T].
- Analysis included pre-operative data (age, deviation angles, fusion, stereoacuity) and post-operative deviation measurements.
- Surgical success was defined by specific post-operative alignment criteria.
Main Results:
- Good near fusion pre-operatively was significantly associated with successful surgical outcomes (P=0.006).
- Smaller immediate and 2-month post-operative deviation angles correlated with better final alignment (P=0.027, P=0.022).
- Peripheral suppression was identified as a factor negatively impacting success rates.
Conclusions:
- Peripheral suppression is a significant factor reducing the success rate of surgery for recurrent X[T].
- Immediate post-operative overcorrection, rather than aiming for perfect alignment, may be a more effective surgical strategy.
- Pre-operative peripheral suppression status and early post-operative deviation measurements are valuable predictors of long-term surgical success.
Background:
To describe factors affecting the prognosis after operation for recurrent intermittent exotropia (X[T]) in children.
Methods:
Clinical records of 50 patients who underwent operation for recurrent X(T) by a single surgeon were reviewed. The age at diagnosis of X(T), and first and second operations, deviation angle at distance and near, surgical method, concurrent vertical strabismus, stereoacuity, and Worth's Four Dot (W4D) examination before reoperation were analyzed, along with the postoperative deviation angle. A successful surgical outcome was defined as orthophoria, esodeviation ≤ 5 prism diopters, or exodeviation ≤ 10 prism diopters at distance.
Results:
Among the 50 recurrent exotropes who underwent surgery and were followed up for more than 1 year postoperatively, 13 showed recurrent exotropia and 1 showed consecutive esotropia. The mean age at reoperation was 8.49 ± 2.19 years, and the mean duration of postoperative follow-up was 27.78 ± 12.02 months. Good near fusion before reoperation was a significant factor in the success of surgery (P = 0.006). Smaller postoperative deviation angle measured immediately and 2 months after surgery were related to smaller final deviation angle (P = 0.027 and P = 0.022, respectively).
Conclusion:
Peripheral suppression lowers the success rate of operation for recurrent X(T) in children. Overcorrection rather than orthotropia should be the target of immediate postoperative deviation angle. Peripheral suppression status and immediate and 2-month postoperative deviation angle may be important clues for predicting the final result of operation for recurrent X(T).
