Non-surgical management options of intermittent exotropia: A literature review
Samira Heydarian1, Hassan Hashemi2, Ebrahim Jafarzadehpour3, Amin Ostadi2, Abbasali Yekta4, Mohamadreza Aghamirsalim5, Nooshin Dadbin2, Hadi Ostadimoghaddam6, Fahimeh Khoshhal7, Mehdi Khabazkhoob8
1 Department of Rehabilitation Sciences, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
2 Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
3 Department of Optometry, Iran University of Medical Sciences, Tehran, Iran
4 Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
5 Eye Research Center, Tehran University of Medical Sciences, Tehran, Iran
6 Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
7 Dezful University of Medical Sciences, Dezful, Iran
8 Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran
Source of Support: None, Conflict of Interest: None
Purpose: To review current non-surgical management methods of intermittent exotropia (IXT) which is one of the most common types of childhood-onset exotropia.
Methods: A search strategy was developed using a combination of the words IXT, divergence excess, non-surgical management, observation, overcorrecting minus lens therapy, patch/occlusion therapy, orthoptics/binocular vision therapy, and prism therapy to identify all articles in four electronic databases (PubMed, Web of Science, Google Scholar, and Scopus). To find more articles and to ensure that the databases were thoroughly searched, the reference lists of the selected articles were also reviewed from inception to June 2018 with no restrictions and filters.
Results: IXT is treated when binocular vision is impaired, or the patient is symptomatic. There are different surgical and non-surgical management strategies. Non-surgical treatment of IXT includes patch therapy, prism therapy, orthoptic sessions, and overcorrecting minus lens therapy. The objective of these treatments is to reduce the symptoms and the frequency of manifest deviation by decreasing the angle of deviation or enhancing the ability to control it.
Conclusions: Evidence of the efficacy of non-surgical management options for IXT is not compelling. More comprehensive randomized controlled trial studies are required to evaluate the effectiveness of these procedures and detect the most effective strategy.