Secondary exotropia: a retrospective analysis of matched cases

Secondary exotropia, that is exotropia following surgery for esotropia, remains frustratingly common, even among experienced strabismologists. In this study, we have compared a group of secondary exotropia cases with a matched group of cases of residual esotropia. Of the factors analyzed, only the presence of an A- or V-pattern preoperatively (P = .0077), the presence of limited postoperative adduction (P < .001), and postoperative binocular function (P = .0073) identified the secondary exotropes. The presence of reduced adduction postoperatively in subjects with secondary exotropia was a poor prognostic sign with 11 of the 13 cases requiring further surgery for poor cosmesis. The authors suggest two subclassifications of secondary exotropia.