Systematic review of management options for intermittent exotropia
Reviewed by Fiona Rowe

The authors conduct a robust systematic review of the literature to report evidence on non-surgical and surgical treatment options for intermittent exotropia – divergence excess and basic intermittent exotropia types. Discussion centres on (1) optical correction of refractive error with options for hyperopic and myopia requirements; (2) observation, considering stability of the deviation and need for management if intermittent exotropia deteriorates with loss of binocular control; (3) occlusion, as a passive anti-suppression procedure with administrative options such as occlusion of the dominant eye, alternate occlusion, daily dosage, indications, compliance and adverse events; (4) over minus correction, considering treatment effect, indications, administrative options of -1.00 to -4.00DS, and compliance; (5) prisms, considering general use and for treatment of surgical overcorrection; (6) vision therapy, including age, treatment effect, indications, angle of deviation, home vs office options, number of sessions and long-term follow-up; (7) definition of cure in terms of angle of deviation plus functional cure; and (8) surgery, including indications, surgical success rates, age and surgical outcome, preoperative prognostic factors, determining maximum angle for surgical planning, surgical methods, residual and recurrent exotropia, overcorrection and adverse events. The authors conclude that quality of evidence is improving but there is still a need for further trials to determine effectiveness of management options.

Divergence excess and basic exotropia types of intermittent exotropia: a major review. Part 2: Non-surgical and surgical treatment options.
Ma MM-L, Scheiman M.
STRABISMUS
2024;32(3):159–94.