Consecutive Exotropia

Question 1

what is consecutive exotropia

Answer 1

a exotropia occuring in a patient with a history of esotropia

it may be
spontaneous
post operative
- in the initial post op period planned/ unplanned
late - often presented as adult years after original surgery

Question 2

what are the managment options for early post op consecutive exotropia

Answer 2

if their is a suspected dettached muscle then surgical intervention is needed

if not and it is a small angle without symptons then reduce the hypermetropic or myopic perscription

non surgical management includes -

reduce hypermetropic or increase myopic perscription

prisms to correct diplopia or consolidate bsv

botulinum toxin

surgery perfromed if they are concerenced over their appereance and symptons

Question 3

what are the features of late postoperative

Answer 3

most patients presented between 20-30 years but range 4-64

large angle the older the presentation the larger the angle mean 45 diopters range 10-90

adduction of the eye limitied in one or both eyes (92%)

amblyopia 58%

alphabet pattern 44%

hypermetropia 25%

diplopia 25%

Question 4

what are some of the managemnt options for consecutive exotropia

Answer 4

a reduction in hypermetropic correction or prisms if diplopia and small angle

botulinum toxin

if unwilling or unfit for surgery

repeat injections required

Question 5

what are the aims of surgery

Answer 5

to a achieieve a post operative overcorrection of 5-10 diopters

improve any adduction defecit

• choice

small angles single muscle surgery may be sufficent

-langle angles two or more muscle surgery

large lateral rectus recession with medial rectus advancement is common

Question 6

what are the steps for management of a consecutive exotropia case

Answer 6

establish any risk of post- op diplopia
- post op diplopia test

options - bt injection (repeat)

surgery