Intermittent Exotropia: The Effect of Alternating Occlusion Therapy on Control of Strabismus.

Background: Intermittent exotropia is a common form of pediatric strabismus characterized by intermittent misalignment of the eyes. This study investigated the clinical effectiveness of alternating occlusion therapy as a non-surgical alternative for children aged 3-10 with intermittent exotropia.

Methods: A comprehensive review of recent research, including randomized controlled trials and case series, was conducted. These studies utilized standardized control scores to assess the impact of alternating occlusion therapy on both distance and near control of alignment.

Results: The findings indicated a significant improvement in exotropia control, particularly at distance fixation, among children undergoing alternating occlusion therapy. While some variability in outcomes exists, all articles demonstrate positive responses to this noninvasive approach. Notably, the patients with poor initial control tended to benefit the most.

Discussion: The potential advantages of alternating occlusion therapy are its cost-effectiveness and noninvasive nature. However, it is essential to manage patient and parental expectations and address potential drawbacks, including social stress, irritation associated with occlusion therapy and the possibility that strabismus surgery may still be needed in the future because of decompensation.

Conclusion: Alternating occlusion therapy is a promising option to improve exotropia control in children with intermittent exotropia. It offers a viable non-surgical strategy to delay or potentially avoid strabismus surgery, although approximately 45% of the patients might eventually still require strabismus surgery. Healthcare providers should carefully weigh the benefits and limitations of this intervention to make informed decisions through shared decision-making with the patients and their families. This review offers diverse insights into the clinical management of intermittent exotropia and provides an evidence-based alternative to surgical interventions.