Understanding Exotropia: Causes, Symptoms, and Treatment Options

Exotropia is a form of strabismus (eye misalignment) characterised by the outward turning of one or both eyes. Also known as “divergent strabismus,” this condition presents unique challenges.

In this blog post, we will delve into the causes, symptoms, and treatment options for exotropia, emphasising the importance of understanding and addressing this eye misalignment.

Types of Exotropia

There are several types of exotropia:

  1. Intermittent Exotropia: This type of exotropia occurs occasionally, such as when a person is tired or focusing on something for an extended period. The eye may turn outward only some of the time.

  2. Constant Exotropia: In constant exotropia, the eye always turns outward, even when the person is not fatigued or concentrating.

  3. Sensory Exotropia: Sensory exotropia is often associated with poor vision in one eye due to a condition like cataracts or a droopy eyelid. The brain may prioritise the better-seeing eye, causing the other eye to deviate outward.

  4. Acute Exotropia: Acute exotropia is a sudden onset of outward eye deviation, which may indicate a neurological or muscular issue and requires immediate medical attention.

  5. Divergence Excess Exotropia: This type of exotropia is characterised by a greater deviation of the eyes when looking into the distance compared to when focusing on near objects.

  6. Basic Exotropia: Basic exotropia involves a constant, equal outward deviation of both eyes, regardless of where the person is looking.

  7. Essential Infantile Exotropia: This rare form of exotropia typically manifests during infancy and persists into childhood. It may require early intervention to prevent long-term vision problems.

Each type of exotropia may have different underlying causes and may require different treatment approaches, such as corrective lenses, vision therapy, or surgery, depending on the severity and individual circumstances.

Causes of Exotropia

  1. Intermittent distance exotropia: This is a common condition that develops in childhood, with a divergent strabismus usually observed when the child focuses on something far away, or when in sunlight.


  2. Muscle Imbalance: Similar to esotropia, exotropia often results from an imbalance in the muscles responsible for eye movement. Weaker muscles that control inward eye movement can lead to the eyes drifting outward.


  3. Neurological Factors: Certain neurological conditions, such as cranial nerve palsies or brain injuries, can disrupt the coordination of eye movements and contribute to exotropia.


  4. Genetic Predisposition: Like esotropia, exotropia can have a genetic component, and individuals with a family history of strabismus may be more susceptible to developing this condition.


Symptoms of Exotropia

  1. Outward Eye Deviation: The primary symptom of exotropia is the outward turning of one or both eyes, creating a divergent appearance. The misalignment may be constant or intermittent.


  2. Double Vision: Exotropia can lead to double vision, where the brain receives conflicting signals from the misaligned eyes. The brain may suppress the image from one eye to alleviate visual confusion.


  3. Difficulty with Depth Perception: Individuals with exotropia may experience challenges in judging depth and spatial relationships, affecting activities that require accurate depth perception.


  4. Eye Fatigue and Headaches: Straining to align the eyes can result in eye fatigue and headaches, especially during activities that demand prolonged visual focus.

Treatment Options

  1. Glasses or Contact Lenses: Correcting refractive errors with prescription glasses or contact lenses can help manage exotropia associated with farsightedness or astigmatism.
  2. Eye exercises: Eye exercises are aimed at improving eye coordination, strengthening muscles, and enhancing binocular vision. This approach may be beneficial for managing some forms of exotropia.
  3. Prism Lenses: Prism lenses can be prescribed to help redirect light entering the eyes, reducing symptoms of double vision in selected cases.
  4. Eye muscle (strabismus) Surgery: Strabismus Surgery may be recommended to adjust the eye muscles and correct the misalignment, especially in cases where other treatments prove insufficient.


Exotropia may pose challenges, but with early intervention and personalised care, it can be a treatable condition. At Clarity Eye Surgeons, under the expertise of Dr Parth Shah, we specialise in advanced treatments tailored to your unique needs. Whether or not it involves eye muscle surgery, our focus is on enhancing your eye health and quality of life.

Don’t let exotropia impact your vision. Contact us today for the first step towards a clearer and more comfortable future.

Author Bio

Dr Parth Shah is a director and principal ophthalmologist at Clarity Eye Surgeons in Canberra, specialising in strabismus surgery and cataract surgery. With extensive training and experience, he is renowned for his expertise in the field. Dr Shah is dedicated not only to performing successful surgeries but also to patient education. His compassionate approach, combined with technical proficiency, has earned him the trust and gratitude of countless patients. He is a true advocate for eye health and a trusted name in the Canberra ophthalmology community.


Exotropia may improve or resolve on its own in some cases, particularly in young children with mild forms of the condition. However, it is important for individuals with exotropia to receive appropriate evaluation and management from an eye care professional to ensure optimal vision and eye health. Without intervention, exotropia may persist or worsen over time, leading to potential vision problems and decreased quality of life.

Exotropia surgery is typically recommended for children who have persistent exotropia that significantly affects their vision or quality of life. The ideal age for surgery can vary depending on factors such as the severity of the exotropia and the child’s overall health. However, it is often performed between the ages of 2 and 4 years old, although older children and adults can also undergo surgery if needed.

While there is no guaranteed way to prevent intermittent exotropia from worsening, early detection and treatment can help manage the condition and potentially prevent it from becoming more severe. Vision therapy, eye exercises, and wearing corrective lenses or eye patches may be recommended by an eye care professional to improve eye alignment and strengthen eye muscles.

In some cases, children with intermittent exotropia may outgrow the condition, especially if it is mild. However, it is important for children with exotropia to receive regular eye exams to monitor their condition and ensure appropriate treatment if needed. While some individuals may experience periods where their exotropia improves or resolves, others may require ongoing management throughout their lives.

Closing one eye can help individuals with intermittent exotropia temporarily control their eye alignment and reduce double vision. By closing one eye, they may be able to maintain single vision and avoid the outward deviation of the eyes associated with exotropia. However, this is not a long-term solution and does not address the underlying cause of the condition.

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