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Wandering Eyes

Exotropia is an eye problem which causes one or both of the eyes to deviate outwards. It usually begins between the ages of two and four, but some may also be born with it. Initially, this outward deviation of the eyes may only be seen when the child is tired or not feeling well. It is more noticeable when the child looks into the distance. The child may frequently squint or rub his eyes.

What Causes The Problems?

Unknown. Many patients have a family history of the condition.

Other Disorders Associated With Misalignment Of The Eyes

  • Retinopathy Of Prematurity - Premature babies sometimes suffer from this. The blood vessels grow abnormally from the retina into the normally clear gel that fills the back of the eye. Here, the vessels are fragile am often haemorrhage into the eye. Doctors say that while many babies may gradually recover from this problem, about one in 10 will develop more severe retinal disease.

  • Retinoblastoma or cancer of the retina.

  • Traumatic Brain Injury.

  • Apert Syndrome - A genetic defect characterised by malformations of the skull which is prematurely fused and unable to grow normally.

  • Prader-Willi Syndrome - A genetic disorder which results in poor growth, short stature, problems in ability to think, perceive, reason or remember, and when not carefully managed obesity.

  • Cerebral Palsy.


The eye doctor will perform tests to set if the patient suffers from exotropia. These tests include looking at the 12 muscles next to the eyeball and their impact on the eye movement, and evaluating the internal structures of the eye using eye drops that dilate the pupils.


According to experts, treatment depends on the severity of the misalignment. Human beings have the natural ability to control the eye muscles, converging them so they don't look misaligned. However, when the misalignment becomes severe, then there is a problem either with the sight or the misaligned eye becomes lazy.

When the patient is under the age of seven, the brain manages to suppress the abnormal image by switching off the lazy eye. When the child gets older, the brain can no longer suppress the abnormal image and the patient ends up with double vision. And if only one eye is being used, then there is no perception of depth and the inability to see three-dimensional images.

There Are Three Widely Used Surgical Approaches

Swan Incision

A cut is made through the conjunctiva and Tenon's capsule (a thin connective-tissue membrane sheathing the eyeball behind the conjunctiva), over one of the muscles next to the eyeball that is repositioned to correct the deviation.

Limbal Incision

A conventional exposure of a horizontal rectus muscle through a cut in the conjunctiva and Tenon's capsule directly over the muscle. The muscle is usually moved backwards and held in place with sutures. One of the disadvantages of this method that is after the surgery, the tear film would be affected in some patients, resulting in localised dryness of the eye.

Cul-De-Sac Or Fornix Incision

Made in the fornix of the eye. Surgeons have to manipulate their way in to reach the muscle in question and often need the help of an assistant, making the method less popular. However, despite all that, the outcome of this method is very good for the patient. No suture is needed and there is less post-operative pain.

This method is particularly good for children, as they have thick Tenon's capsule and therefore, there is no risk of tearing. Also, the patient is able to open his eye straightaway after the operation. However not everyone is suitable for this method. Older patients with thinner conjunctiva and patients with scarred eyeballs are not suitable.


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