infantile exotropia

Question 1

infantile exotropia

Answer 1

• Exotropia for near and distance, Likely Amblyopia
• Onset < 12 months = infantile XT

Question 2

Characteristics of infantile xot ?

Answer 2

• Large-angle alternating XT
• Possible reduction on accommodation
• DVD probable (12-20% of pts with DVD were XT)
• Rare – common in neonates but resolves by 3/12
• Pathology should always be considered if unilateral constant XT in child
• Associated with severe craniofacial abnormality

Question 3

Investigations for infantile xot?:

Answer 3

• Case history
• Refraction
• VA
• CR
• CT
• Prism reflections/Krimsky/PCT
• Pupils
• Conv
• OM

BSV potential
* Poor prognosis in significant XT or amblyopia
O PAT – impractical with large angles
O Synoptophore – high false negative
O BT – one or both LR to temporarily correct

Question 4

Non-Surgical Management for infantile xot?

Answer 4

Correct any refractive error
* Refractive adaptation
* Treat any amblyopia (if of a treatment age) (Strabismic amblyopia implies early onset constant)

Botulinum toxin
* Useful in those not wanting / suitable for surgery
* May become stable if BSV after injection
* Regular repeat injections often needed