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Key Features

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  • Type of strabismus in which the eyes are divergent/wall-eyed

  • May be intermittent or constant and involve one or both eyes

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Clinical Findings

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  • Deviation of the eyes toward the ears most often begins intermittently and occurs after age 2 years

  • Congenital exotropia is extremely rare in an otherwise healthy infant

  • Early-onset exotropia may occur in infants and children with severe neurologic problems

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Diagnosis

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  • Evaluation of the corneal light reflex reveals the penlight's reflection in the deviated eye is displaced nasally

  • All children with constant, congenital exotropia require CNS neuroimaging

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Treatment

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  • Surgery

  • Orthoptic exercises

  • Patching

  • Glasses (occasionally)

  • Referral to an ophthalmologist is indicated

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