EXOTROPIA. GEORGE N PAPANIKOLAOU SHO OPHTHALMOLOGY SINGLETON HOSPITAL SWANSEA. BURIAN’S CLASSIFICATION. INTERMITTENT Basic Divergence excess Convergence insufficiency Simulated or Pseudo-Divergence excess. KUSHNER’S CLASSIFICATION. CONSTANT CONCOMITANT
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GEORGE N PAPANIKOLAOU
Age: 6/12- 4y/ F>M/ >10/ uni-, bilateral
1% of population
? Progressive/ stable/ improve
A and V patterns/ hypertropias
No amblyopia/ Good stereopsis
No diplopia when exo (suppression+ARC)
Panoramic vision (large angle/ no confusion)
Fatigue/ illness/ day dreaming/ visual distraction-inattention/ distance viewing/ alcohol/ sedatives
EVALUATION OF IDEX
MANAGEMENT BASED ON KUSHNER’S CLASSIFICATION
BENEFITS OF TREATMENT
Main ResultsNo studies were found that met our selection criteria and therefore none were included for analysis.
Reviewers' conclusionsThe available literature consists mainly of retrospective case reviews. These are difficult to compare and analyse due to a large variation in the definition of intermittent distance exotropia, intervention criteria and outcome measures. However there seems to be general agreement that non-surgical treatment is most appropriate in small angle deviations or as a supplement to surgery. Studies were found supporting both early and late surgical intervention so the optimal timing of surgical intervention cannot be concluded. Recent work indicates that bilateral surgery may be the most effective surgical procedure in these cases. There is clearly a need for carefully planned clinical trials to be undertaken to improve the evidence base for the management of this condition.
This review should be cited as:Richardson S, Gnanaraj L Interventions for intermittent distance exotropia (Cochrane Review). In: The Cochrane Library, Issue 4, 2003. Chichester, UK: John Wiley & Sons, Ltd.