Long-Standing, Large-Angle Exotropia in Adults

INTRODUCTION AND PURPOSE: This study examines the sensory and motor results in adult patients with large-angle exotropia treated with nonadjustable bilateral recess-resect procedures. METHODS: A consecutive series of adult patients undergoing four-muscle surgery for exotropia ≥ 50(Δ) with no previous surgery were identified by retrospective medical record review. All patients had nonadjustable symmetric bilateral medial rectus resections and bilateral lateral rectus recessions performed between 1995 and 2006. Data on postoperative alignment, stereoacuity, and the presence or absence of diplopia were collected. RESULTS: Eight patients met the inclusion criteria. Seven of eight patients required only one surgical procedure for correction of the exotropia with final postoperative deviations within 10(Δ) of orthophoria. One patient required reoperation resulting in a final postoperative measurement of 10(Δ) of esotropia. At final examination, no patient reported diplopia. Four of eight patients had postoperative stereoacuity ranging from 200 to 40 seconds of arc. CONCLUSIONS: Long-standing, presumably constant, large-angle exotropia does not preclude the recovery of stereopsis after surgical alignment. Permanent postoperative diplopia did not occur in our series. In spite of the large deviations, non-adjustable surgery produces good alignment in most cases, possibly because these patients retain some fusion ability.