Accommodative and Fusional Convergence in Intermittent Exotropia

Abstract

Background and Purpose The purpose of this paper is to provide a systematized review of the published literature addressing accommodative and fusional convergence in intermittent exotropia. This paper will summarize a variety of clinical techniques suggested to enhance assessment of intermittent exotropia. Method A search of published, peer-reviewed literature available in the English language was performed using MEDLINE, PubMed, CINAHL, Health Source, and PsycINFO databases. There was no date limitation set. Key words used were exotropia, intermittent exotropia, convergence, fusional convergence, and accommodative convergence. In addition, relevant classic articles cited in the retrieved articles not appearing in the initial search were reviewed. Results Fifty relevant articles were reviewed and summarized. The topics fell into several distinct categories: general descriptions of the characteristics of intermittent exotropia and vergence; the relationship of several types of convergence to the features of intermittent exotropia; methods of accurately assessing the angle of the deviation; and surgical vs. nonsurgical options for treatment of this disorder. Conclusion Accurate clinical assessment is crucial in the eventual successful management of intermittent exotropia. Understanding the interaction of fusion and accommodation with convergence in the control of intermittent exotropia will enhance targeted decision making in the development of treatment plans.