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Volume 48, 1998, p. 2529

Management of Intermittent Exotropia: For Surgery (Abstract)
Edward L. Raab, M.D.

Almost all patients with intermittent exotropia require surgical correction at some point. Nonoperative measures furnish normal binocular sensory input to the misaligned eyes to encourage compensation and proper binocular visual function, even under the abnormal motor circumstances. However, while this is valuable adjunctive treatment, it rarely is sufficient alone. Surgery done while fusion is still exercised at least part-time gives better results, and reported studies indicating disappointing success rates may not have made this distinction. The dangers of early surgery in younger patients include persisting overcorrection and monofixation syndrome even when alignment is successfully restored. Permanent overcorrection is not more likely to occur after initial postoperative esotropia of 11-20 PD. than after smaller esodeviations. When monofixation syndrome occurs, secure peripheral fusion, at least partial stereopsis and visual comfort replace frequent divergence with visual annoyance and a noticeable cosmetic defect.