Clinical Manifestation and Surgical Outcomes of Consecutive Exotropia

Purpose: To evaluate the causative factors related to the development of consecutive exotropia and surgical outcomes. Methods: We reviewed the surgical results of 53 patients underwent strabismus surgery for consecutive exotropia retrospectively. The followings were checked before surgery: onset of exotropia, visual acuity, angle of deviation, presence of vertical deviation, ocular motility including adduction limitation, refractive errors, and sensory status. Results: There were 3 different types of preceding esotropia: infantile esotropia 43 patients, accommodative esotropia 8 patients, and partially accommodative esotropia 2 patients. Forty-three patients underwent surgery for esotropia developed exotropia after 69.8 months of follow-up. On the other hand, 10 patients of spontaneous consecutive exotropia showed outward deviation after 8.3 years from the onset of esotropia. Consecutive exotropia were accompanied with the other ocular deviations in 33 patients. A-pattern exotropia was accompanied in 24.5% of patients and it was more common than V-pattern developed in 9.4% of patients. Limitation of adduction after surgery for esotropia was found in 20.9%, amblyopia in 47.2%, and nystagmus in 13.2% respectively. The mean preoperative and postoperative exodeviation was 32.6 PD, 7.5 PD respectively. At 1 year and last follow-up, 20 of 30 patients and 38 of 53 patients showed the satisfactory surgical outcomes, respectively. Conclusions: We found out that consecutive exotropia was frequently accompanied with cyclovertical deviations, especially A-pattern exotropia. Presence of amblyopia and adduction limitation after correction for esotropia may be the causative factors of the consecutive exotropia. However, these factors were not statistically associated with unsuccessful outcomes (p>0.1, test). Twenty of 30 patients (66.7%) revealed satisfactory results at 1 year follow-up.