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Nonsurgical Consecutive Exotropia Following Childhood Esotropia: A Multicentered Study.

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Nonsurgical consecutive exotropia (NCX) can occur in children with esotropia (ET), challenging the link to high hyperopia. Conservative management shows modest results, suggesting further study into nonrefractive causes.

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Area of Science:

  • Ophthalmology
  • Pediatric Ophthalmology
  • Strabismus

Background:

  • Nonsurgical consecutive exotropia (NCX) is the spontaneous conversion of esotropia (ET) to exotropia (XT) without surgery.
  • The exact cause of NCX, particularly its association with high hyperopia and accommodative ET, remains unclear.

Purpose of the Study:

  • To describe the clinical features of NCX.
  • To evaluate the effectiveness of conservative management strategies for NCX.

Main Methods:

  • A retrospective, multicenter observational case series.
  • Included patients aged 6 months and older with initial ET converting to XT without surgery, excluding sensory strabismus.
  • Collected data on age, visual acuity, refractive error, deviation, and binocular vision.

Main Results:

  • Forty-nine children were analyzed, with NCX occurring around age 8.4 years.
  • Accommodative ET was present in 60% of cases, and only 35.7% had high hyperopia.
  • Refractive management (reducing hyperopic prescription) yielded modest results, with only one case reverting to ET; 43% eventually required XT surgery.

Conclusions:

  • NCX occurs in both accommodative and nonaccommodative ET, with high hyperopia present in only a minority of cases.
  • The average time for the drift from ET to XT is within 5 years.
  • Findings question hyperopia-linked causation theories, emphasizing the need to explore nonrefractive factors like the vergence system.