Journal List > J Korean Ophthalmol Soc > v.58(11) > 1010664

J Korean Ophthalmol Soc. 2017 Nov;58(11):1248-1253. Korean.
Published online November 15, 2017.
©2017 The Korean Ophthalmological Society
Clinical Features of Recurrent Intermittent Exotropia after Reoperation for Intermittent Exotropia
Tae Jin Kim, MD and Dae Hyun Kim, MD, PhD
Department of Ophthalmology, Chosun University School of Medicine, Gwangju, Korea.

Address reprint requests to Dae Hyun Kim, MD, PhD. Department of Ophthalmology, Chosun University Hospital, #365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea. Tel: 82-62-220-3190, Fax: 82-62-225-9839, Email:
Received July 13, 2017; Revised September 06, 2017; Accepted October 20, 2017.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.



We reviewed the clinical features of intermittent exotropic patients who experienced recurrence after reoperation for intermittent exotropia, and identified the risk factors and prognoses.


The incidences, risk factors, treatment modalities, and prognoses of patients with recurrent exotropia were analyzed in 39 patients who underwent reoperation due to a relapse of exotropia after the first intermittent exotropia.


Among 39 patients, 24 (61.5%) had recurrent intermittent exotropia and 15 patients had no recurrence with intermittent exotropia. There was no difference in the recurrence of intermittent exotropia with age, deviation, refraction, anisometropia, outward discrepancy, and the vertical deviation before the reoperation. However, when the first operation was performed with bilateral lateral rectus recession and the reoperation was performed with bilateral medial rectus resection or unilateral medial rectus resection, intermittent exotropia tended to recur more than when the first operation was performed with one eye with lateral rectus recession and medial rectus resection, followed by reoperation with the other lateral rectus recession and medial rectus resection (p < 0.05). In addition, an esodeviation <10 prism diopters, orthophoria, or exotropia on the first postoperative day showed a tendency to relapse more than an esodeviation >10 prism diopters (p < 0.05).


The factors affecting recurrence after intermittent exotropia surgery involve surgical factors such as the surgical method and the postoperative overcorrection.

Keywords: Clinical features of recurred exotropia; Intermittent exotropia; Recurred exotropia; Recurrent exotropia


Table 1
Probable factors associated with onset of multiple recurred exotropia after reoperation of intermittent exotropia
Click for larger image

Table 2
Clinical features of patients who underwent intermittent exotropia surgery three times
Click for larger image


This study was presented as a narration at the 117th Annual Meeting of the Korean Ophthalmological Society 2017.

This study was supported by research fund from Chosun University, 2016.

Conflicts of Interest:The authors have no conflicts to disclose.

1. Figueira EC, Hing S. Intermittent exotropia: comparison of treatments. Clin Exp Ophthalmol 2006;34:245–251.
2. Oh JY, Hwang JM. Survival analysis of 365 patients with exotropia after surgery. Eye (Lond) 2006;20:1268–1272.
3. Ekdawi NS, Nusz KJ, Diehl NN, Mohney BG. Postoperative outcomes in children with intermittent exotropia from a population-based cohort. J AAPOS 2009;13:4–7.
4. Ruttum MS. Initial versus subsequent postoperative motor alignment in intermittent exotropia. J AAPOS 1997;1:88–91.
5. Keenan JM, Willshaw HE. The outcome of strabismus surgery in childhood exotropia. Eye (Lond) 1994;8(Pt 6):632–637.
6. Stoller SH, Simon JW, Lininger LL. Bilateral lateral rectus recession for exotropia. a survival analysis. J Pediatr Ophthalmol Strabismus 1994;31:89–92.
7. Gezer A, Sezen F, Nasri N, Gözüm N. Factors influencing the outcome of strabismus surgery in patient with exotropia. J AAPOS 2004;8:56–60.
8. Hahm IR, Yoon SW, Baek SH, Kong SM. The clinical course of recurrent exotropia after reoperation for exodeviation. Korean J Ophthalmol 2005;19:140–144.
9. Kim SJ, Choi DG. The clinical analysis after reoperation for recurrent intermittent exotropia. J Korean Ophthalmol Soc 2007;48:321–327.
10. Raab EL, Parks MM. Recession of the lateral recti. Early and late postoperative alignments. Arch Ophthalmol 1969;82:203–208.
11. Knapp P. In: Management of exotropia in Transactions of the New Orleans Academy. St. Louis: CV Mosby; 1971. pp. 233-241.
12. Choi DG, Kim PS. The surgical outcome of intermittent exotropia and the prognostic factors. J Korean Ophthalmol Soc 1998;39:1255–1263.
13. Kim WJ, Kim MM. The clinical course of recurrent intermittent exotropia after previous unilateral recess-resection surgery. J Korean Ophthalmol Soc 2009;50:1386–1391.
14. Mun HJ, Kim MM. Comparison of surgical results between bilateral recession and unilateral recession-resection in 25 PD intermittent exotropia. J Korean Ophthalmol Soc 2002;43:2202–2207.
15. Hur J, Won IG. Surgical results of 79 cases of intermittent exotropia in children. J Korean Ophthalmol Soc 1990;31:114–119.
16. Kushner BJ. Selective surgery for intermittent exotropia based on distance/near differences. Arch Ophthalmol 1998;116:324–328.
17. Rayner JW, Jampolsky A. Management of adult patients with large angle amblyopic exotropia. Ann Ophthalmol 1973;5:95–99.
18. Richard JM, Parks MM. Intermittent exotropia. Surgical results in different age groups. Ophthalmology 1983;90:1172–1177.
19. Edelman PM. Consecutive esodeviation…then what? Am Orthopt J 1988;38:111–116.