Evaluation and Treatment of Intermittent Exotropia | Journal of Pediatric Ophthalmology and Strabismus

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The parents note that the eye drifted intermittently but aren&rsquo;t sure how often, at least daily. The patient seems to fixate well from each eye and has an intermittent exotropia of 30 prism diopters at both distance and near. Side gaze is difficult to measure but we&rsquo;ll assume that it is comitant. You notice that one eye seems to stay out "/><meta id="metaKeywords" name="keywords" content="Journal of Pediatric Ophthalmology and Strabismus,Ophthalmology,Pediatrics,Pediatrics/Strabismus,Eye to Eye"/><meta id="Meta1" name="scID"/><meta id="scID" name="scID"/><meta name="PostedDate" content="2013-07-01"/> <meta name="specialties" content="Ophthalmology,Pediatrics"/> <meta name="specialty" content="Ophthalmology"/> <meta name="specialty" content="Pediatrics"/> <meta name="primary_specialty" content="Ophthalmology"/> <meta name="subspecialties" content="Pediatrics/Strabismus"/> <meta name="subspecialty" content="Pediatrics/Strabismus"/> <meta name="departments" content="Eye to Eye"/> <meta name="department" content="Eye to Eye"/> <meta name="content_type" content="Journal Article"/> <meta name="pageid" content="{FF0A078C-C0E0-4FF7-985B-6836982DB964}"/> <meta property="og:image" content="https://web.archive.org/web/20130820210907im_/http://213a1ca8842e5e699a80-05ce35571e92a3f7383a191aa5840bba.r66.cf1.rackcdn.com/healio_safe_image.png"/><meta name="pubabbv" content="JPOS"/><meta name="authors" content="Cynthia Alley MD, James A. Deutsch MD, Kammi B. Gunton MD"/><meta name="articleid" content="{FF0A078C-C0E0-4FF7-985B-6836982DB964}"/><meta name="legacyarticleid" content=""/><meta name="article-title" content="Evaluation and Treatment of Intermittent Exotropia"/><meta name="article-link" content="/ophthalmology/journals/JPOS/{FF0A078C-C0E0-4FF7-985B-6836982DB964}/Evaluation-and-Treatment-of-Intermittent-Exotropia"/><meta name="doi" content="10.3928/01913913-20130708-01"/><meta name="pubname" content="Journal of Pediatric Ophthalmology and Strabismus"/><meta name="pubtype" content="print"/><meta name="author" content="Cynthia Alley, MD"/><meta name="author" content=" James A. Deutsch, MD"/><meta name="author" content=" Kammi B. 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<span>›</span> <a href="/web/20130820210907/http://www.healio.com/ophthalmology"> Ophthalmology</a> <span>›</span> <a href="/web/20130820210907/http://www.healio.com/ophthalmology/journals"> Journals</a> <span>›</span> <a href="/web/20130820210907/http://www.healio.com/ophthalmology/journals/jpos"> Journal of Pediatric Ophthalmology and Strabismus</a> </p>    <div id="SeeAlso" class="related-links"><h3>See Also</h3><ul><li><a href="https://web.archive.org/web/20130820210907/http://www.healio.com/ophthalmology/journals/jpos/%7Bf62843bb-da84-48a2-9c1e-54e226396553%7D/combined-optical-and-atropine-treatment-of-children-with-residual-amblyopia-after-atropine-penalization">Combined Optical and Atropine Treatment of Children With ...</a></li><li><a href="https://web.archive.org/web/20130820210907/http://www.healio.com/ophthalmology/journals/jpos/%7Bfe20403d-81b5-4954-89c3-694625f8d105%7D/evaluation-of-retinal-nerve-fiber-layer-thickness-in-patients-with-anisometropic-and-strabismic-amblyopia-using-optical-coherence-tomography">Evaluation of Retinal Nerve Fiber Layer Thickness in Patients ...</a></li><li><a href="https://web.archive.org/web/20130820210907/http://www.healio.com/ophthalmology/journals/jpos/%7B93dbb20b-de91-4a6a-9e9a-02a2a14c43a2%7D/analysis-of-risk-factors-for-consecutive-exotropia-and-review-of-the-literature">Analysis of Risk Factors for Consecutive Exotropia and ...</a></li></ul></div> <div class="journals-content"><div class="journal-tab-group"><ul class="journal-tabs"><li><a href="/web/20130820210907/http://www.healio.com/journals/jpos">Current Issue</a></li><li><a href="/web/20130820210907/http://www.healio.com/journals/jpos/m/oar">Online Advanced Release</a></li><li><a href="/web/20130820210907/http://www.healio.com/journals/jpos/m/olo">Online-Only Articles</a></li><li><a href="/web/20130820210907/http://www.healio.com/journals/jpos/m/past-issues">Past Issues</a></li></ul><div class="journal-panes"><div class="abstract-content"><p class="kicker-top">Eye to Eye </p><h2><a href="#">Evaluation and Treatment of Intermittent Exotropia</a></h2><p class="authors">Cynthia Alley, MD; James A. Deutsch, MD; Kammi B. Gunton, MD</p><div class="journal-info"><ul class="full-text"><li class="header">Read Full Text Article</li><li class="html"><a class="active" title="View Html Version" alt="View Html Version" rel="nofollow" href="/web/20130820210907/http://www.healio.com/buy-journal-or-article?a={FF0A078C-C0E0-4FF7-985B-6836982DB964}&amp;returnUrl=%2fophthalmology%2fjournals%2fJPOS%2f%7bFF0A078C-C0E0-4FF7-985B-6836982DB964%7d%2fEvaluation-and-Treatment-of-Intermittent-Exotropia&amp;jrnl=J0006">Html Icon</a></li><li class="pdf"><a id="pdf" href="/web/20130820210907/http://www.healio.com/buy-journal-or-article?a={FF0A078C-C0E0-4FF7-985B-6836982DB964}&amp;returnUrl=%2fophthalmology%2fjournals%2fJPOS%2f%7bFF0A078C-C0E0-4FF7-985B-6836982DB964%7d%2fEvaluation-and-Treatment-of-Intermittent-Exotropia'%3Fpdf%3D1'&amp;jrnl=J0006" class="active" title="View Pdf Version" alt="View Pdf Version" rel="nofollow">Pdf Icon</a></li></ul><ul class="article-citation"><li>Journal of Pediatric Ophthalmology and Strabismus</li><li>July/August 2013 - Volume 50 · Issue 4: 198-201</li><li class="doi">DOI: 10.3928/01913913-20130708-01</li></ul></div><div class="copyrights" style="float:right;"><a onclick="RightsLinkPopUpV2();" href="#"><img alt="Rights and Permissions" title="Rights and Permissions" border="0" src="https://web.archive.org/web/20130820210907im_/http://213a1ca8842e5e699a80-05ce35571e92a3f7383a191aa5840bba.r66.cf1.rackcdn.com/request-permissions.gif"></img></a><script type="text/javascript" language="javascript">function RightsLinkPopUpV2() { var location="https://web.archive.org/web/20130820210907/https://s100.copyright.com/AppDispatchServlet?publisherName=slack&publication=0191-3913&contentID=10.3928/01913913-20130708-01&publicationDate=2013&copyright=Copyright%20%26copy%3B%202013%2C%20Slack%20Inc.&title=Evaluation%20and%20Treatment%20of%20Intermittent%20Exotropia&volumeNum=50&issueNum=4&author=Cynthia%20Alley%2C%20MD%3B%20James%20A.%20Deutsch%2C%20MD%3B%20Kammi%20B.%20Gunton%2C%20MD%26orderBeanReset%3DTRUE"; window.open(location,'RightsLink','location=no,toolbar=no,directories=no,status=no,menubar=no,scrollbars=yes,resizable=yes,width=650,height=550'); } </script></div><div class="article-tab-group"><ul class="article-tabs"><li><a id="anchor-tab-abstract" href="#">Abstract</a></li><li><a id="anchor-tab-article" href="/web/20130820210907/http://www.healio.com/buy-journal-or-article?a={FF0A078C-C0E0-4FF7-985B-6836982DB964}&amp;returnUrl=%2fophthalmology%2fjournals%2fJPOS%2f%7bFF0A078C-C0E0-4FF7-985B-6836982DB964%7d%2fEvaluation-and-Treatment-of-Intermittent-Exotropia'%3Ffulltext%3D1'&amp;jrnl=J0006">Article</a></li><li class="cite-link"><a href="#" onclick="showCitation();">Get Citation</a><script type="text/javascript">function showCitation() {var w = window.open('', '', 'width=400,height=400,resizeable,scrollbars');w.document.write('Alley C, Deutsch J, Gunton K. Evaluation and Treatment of Intermittent Exotropia. <i>J Pediatr Ophthalmol Strabismus.</i> 2013; 50: 198-201. doi: 10.3928/01913913-20130708-01 <a href="https://web.archive.org/web/20130820210907/http://www.healio.com/ophthalmology/journals/JPOS/{FF0A078C-C0E0-4FF7-985B-6836982DB964}/Evaluation-and-Treatment-of-Intermittent-Exotropia">[link]</a>');w.document.close(); }</script></li></ul></div><div id="abstractPortion"><h4>Abstract</h4><strong>Nelson:</strong> The first case is a 9-month-old child. The parents note that the eye drifted intermittently but aren’t sure how often, at least daily. The patient seems to fixate well from each eye and has an intermittent exotropia of 30 prism diopters at both distance and near. Side gaze is difficult to measure but we’ll assume that it is comitant. You notice that one eye seems to stay out even through blinking. The cycloplegic refraction is +1.0. 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Evaluation and Treatment of Intermittent Exotropia | Journal of Pediatric Ophthalmology and Strabismus