Major Review:

Intermittent Exotropia

Basic and Divergence Excess Type

JEFFREY COOPER, M.S., O.D. and NORMAN MEDOW, M.D.

from the State College of Optometiy, the State University of New York, and the

Department of Pediatric Ophthalmology, Manhattan Eye, Ear and Throat

1—Io.cnitai. New York. New York

I:

NOMENCLATURE &

INCIDENCE

A.

Nomenclature

B.

Incidence

C.

Progression

II:

SENSORY MOTOR FINDINGS

A. Motor findings

1.

AC/A ratio

2.

Results from occlusion

3.

+3.00 lens test

4.

Kushner classification

5.

Cover test findings

6.

Concomitancy

7.

Temporal characteristics

8.

Fusional amplitude

B.

Sensory findings

1.

Stereopsis &

physiological diplopia

2.

Suppression &

panoramic viewing

3.

Anomalous retinal

correspondence

4.

Lack of correspondence

III:

ETIOLOGY

A.

Anatomical/mechanical

B.

Active divergence

C.

AC/A ratio

D.

Phylogenic

E.

Hemiretinal suppression

F.

Genetic

G.

Chameleon Theory

IV:

TREATMENT

A. Orthoptics

1.

Active

2.

Occlusion

3.

Lens therapy

4.

Prism therapy

5.

Biofeedback

6.

Review & Summary of

Orthoptic Treatment

B.

Surgery

1.

History

2.

Intended initial

overcorrection

3.

Early vs late surgery

4.

Consecutive esotropia

5.

Bilateral lateral rectus

recession vs.

recession-resection

6.

Variance in surgical

results

7.

Surgery in older patients

8.

Review & Summary of

Surgical Treatment

C.

Recommended therapy

V:

CONCLUSION

Binocular Vision &

Eye Muscle Surgery Qtrly°

Major Review: Intermittent Exotropia;

Basic and Divergence Excess Type

J.

Cooper, MS. OD and N. Medow, MD

Summer of 1993

Volume 8 (No.3): 185-216

ABSTRACT: Intermittent exotropia is a unique strabismus with a specific set

of sensory motor findings. This paper provides a comprehensive review of

nomenclature, epidemiology, sensory motor findings, theories of etiology, and

treatment of intermittent exotropia, of both basic and divergence excess types.

Acknowledgement:: We thank Norman Haffner, OD, PhD, President of the State College of Optometry for his support; Drs. Schlossman,

Birnbau,n & carniglia for their review; and B. Kenul, H. Hankins, J. Downs & M. Samnulamy for their preparation of this ,nanuscript.

Correspondence and reprint requests: Dr. Cooper, State University of New York, State College of Optometry, 100 East 24th St., New York,

NY 10010. Tel: (212) 780-5011; FAX: (718) 837-0431

187,