Exotropia (Outward Eye Deviation, Squint)

Outward Eye Deviation (Exotropia): Causes, Types, Symptoms, and Treatment Options

Outward eye deviation or outward eye squint medically known as exotropia, is a strabismus problem that can occur in one or both eyes. The eyes are seen looking outwards towards the ears. It is a disease that can be permanent or temporary if it occurs.

It is a condition that usually begins in childhood but is also seen in adults. It may be seen in some patients when they are looking away or when they are absent-minded and sleepless without focusing on anything. Some exotropia patients have a vision problem in one eye and amblyopia develops due to the problem.

After a certain period of time , the eye may deviate outwards due to decreased vision . While external deviation may occur periodically, if it begins to occur frequently, an ophthalmologist should be consulted. Outward deviation of the eye should not be considered as just a visual problem and should be treated to protect eye health.

What Causes Outward Eye Deviation?

Several factors contribute to the development of outward eye deviation. Some patients develop exotropia without a clear cause, while others experience it due to underlying eye or neurological conditions.

Common causes include:

• Amblyopia or vision loss in one eye

• Family history of strabismus

• Damage to the nerves connecting the eye and brain

• Head trauma or vascular diseases

• Systemic conditions such as diabetes, high blood pressure, and thyroid disorders

Previous surgery for inward eye deviation may also lead to exotropia if surgeons excessively weaken or strengthen the eye muscles.

Diagnosis of Outward Eye Deviation

When patients visit an ophthalmologist with outward eye deviation, the doctor first performs a comprehensive eye examination.
During the strabismus evaluation, specialists:

• Measure visual acuity

• Assess eye movements

• Calculate deviation angles at near and distance

• Perform binocular (3D) vision tests

Based on these findings, the physician establishes a precise diagnosis and creates a tailored treatment plan.

Treatment Options for Outward Eye Deviation

Treatment focuses on correcting the underlying cause and restoring eye alignment. Physicians design each treatment plan according to the patient’s age, deviation type, and visual status.

Doctors often begin treatment by:

• Prescribing corrective glasses

• Treating amblyopia when present

• Using occlusion (patching) therapy in children

When non-surgical treatments fail to control the deviation, strabismus surgery becomes necessary. During surgery, the surgeon weakens the outward-pulling muscles and strengthens the inward-pulling muscles to realign the eyes effectively.

Types of Outward Eye Deviation (Exotropia)

Outward eye deviation can appear in both children and adults, and its characteristics vary depending on the underlying cause. Identifying the correct type of exotropia is essential for effective treatment planning.

Sensory Exotropia (Outward Deviation in the Blind Eye)

Outward deviation may occur in an eye with significant vision loss at any age. This condition is known as sensory strabismus, and when the eye drifts outward, it is called sensory exotropia.
Surgical treatment in these cases aims to stabilize the eye position and improve cosmetic alignment.

Intermittent Exotropia

Intermittent outward eye deviation is one of the most common forms, especially in children. It typically appears when the child is tired, ill, daydreaming, or not focusing on a specific object.
Initial treatment often includes glasses and occlusion (patching) therapy. If the deviation becomes more frequent or constant, surgical intervention may be required.

Congenital Exotropia

Congenital outward eye deviation develops within the first six months of life. The condition may be intermittent or constant.
Permanent congenital exotropia is relatively rare. When the deviation is occasional, it may resolve spontaneously; however, regular ophthalmologic follow-up is essential. Progressive cases often require surgical correction.

Exotropia Due to Convergence Insufficiency

This type of outward deviation occurs when focusing on near objects. While one eye maintains fixation, the other drifts outward.
If non-surgical treatments are ineffective, strabismus surgery may be considered to restore proper alignment.

Consecutive Exotropia

Consecutive outward eye deviation develops after surgery for inward eye deviation (esotropia), usually due to excessive weakening or strengthening of the eye muscles.
Although some cases resolve spontaneously, persistent deviation may require a second surgical procedure.

Outward Eye Sliding Surgery

Outward eye deviation surgery is one of the permanent solutions for the problem of strabismus developing outward . During the surgery, the eye muscles are intervened. In the examinations performed before the surgery, it is determined how many eye muscles will be treated.

Outward eye displacement surgeries are performed under local anesthesia in adults and general anesthesia in children, usually lasting 1 hour. It should be known that additional treatments such as glasses or eye drops may be needed after the surgery.

Click here to find more information about strabismus surgery.

Risk Factors for Outward Eye Deviation

Certain factors increase the risk of developing exotropia:

• Family history of eye misalignment

• Neurological disorders

• Difficult or premature birth

• Visual impairment in early childhood

Early screening and regular eye examinations significantly reduce long-term complications.

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