Session: Poster session B

Spontaneous Consecutive Exotropia

Introduction: Consecutive exotropia usually occurs following previous surgery for esotropia. Spontaneous drift from esotropia to exotropia (in the absence of surgery or botulinum toxin treatment) may develop.

Methods: This is an observational review of 32 patients, with different types of esotropia, who developed a spontaneous exotropic shift. They were identified by daily practice between 2019-2023. We looked at the cycloplegic refraction, type of esotropia, the presence of amblyopia at the time of the exoshift, history of occlusion, presence of dissociated vertical deviation and primary inferior oblique overaction, presence of binocular vision, age of the exoshift, medical history, and the amount of exodeviation.

Results: In spontaneous consecutive exotropia following accommodative esotropia patients were well managed by reducing the amount of optical correction. The presence of moderate or severe amblyopia at the time of the exotropia onset precipitates the angle of deviation and the need for surgery. The presence of dissociated vertical deviation and primary inferior oblique overaction was associated with a larger angle of deviation. Associated delay in neurological development may increase the risk for spontaneous consecutive exotropia. Spontaneous consecutive exotropia developed even in cases with good binocularity. Mean age of exotropia onset was around 7.

Conclusion:  Spontaneous exotropia occurs in both accommodative and nonaccommodative esotropia. Long term close follow -up is required even in patients with good alignment and recovered amblyopia. The variability of this condition is high and possible predictive factors are difficult to point out.