What is intermittent strabismus?

Intermittent strabismus refers to a type of strabismus condition that is between exotropia and concomitant exotropia. Generally speaking, it means that the patient's visual axis is often separated, for example, this happens when looking at a distance. At this time, exotropia is prone to occur, and intermittent exotropia will occur. Generally speaking, exotropia may occur before the onset of the disease. In this case, the main reason may be refractive error, which should be corrected with certain methods.

Symptoms of intermittent strabismus Intermittent exotropia often occurs in early childhood. Initially, it only occurs when looking far away. As the disease progresses, the frequency and duration of intermittent exotropia increase, and finally exotropia may also occur when looking close. The manifestation phase of intermittent exotropia often occurs when one is tired, sick, sleepy, or inattentive. Intermittent exotropia may cause temporary diplopia in children with immature vision, which is quickly followed by suppression and abnormal retinal correspondence. A common symptom is photophobia. When outdoors in daylight, the patient often closes one eye. The reason is unknown. It is estimated that the patient is looking at distant targets outdoors and there is no nearby object stimulation to make the two eyes converge. The bright sunlight flickers the retina and interferes with fusion. The patient's exotropia becomes obvious. However, it is not necessarily certain that the patient closes one eye to avoid diplopia. It is possible that the bright light affects the fusion convergence amplitude of the patient with intermittent exotropia, causing one eye to close. Intermittent exotropia may be accompanied by AV sign and other vertical strabismuses, such as dissociated hypertropia.

How should intermittent exotropia be treated? 1. Patients with obvious refractive errors in ciliary muscle paralysis refractive examination, especially astigmatism and anisometropia, should be fully corrected to ensure a clear retinal image; surgery should be accompanied by myopia, which should be fully corrected; for exotropia accompanied by hyperopia, correcting hyperopia will reduce accommodative convergence and increase exotropia. Whether full or partial correction is needed depends entirely on the degree of hyperopia, patient age and AC/A ratio, which is usually less than +2.00D in infants and young children, no correction is required. For older patients, correction of hyperopia is usually necessary to avoid refractive fatigue. Elderly people have exotropia and presbyopia, and their accommodation is weakened. If they have hyperopia, they need correction and can be given the minimum degree to facilitate near vision. 2. Minus spherical lens: Using a minus lens to correct intermittent exotropia can be used as a temporary measure, or placed in the upper half of the bifocal lens to treat excessive separation; or placed in the lower half of the bifocal lens to treat insufficient convergence, stimulate accommodative convergence, and control exotropia. This treatment method should not be recommended. Children treated with this method often suffer from visual fatigue. 3. Prism and patch therapy. The base-pointing prism can strengthen the stimulation of the fovea of ​​both eyes. About 1/2 to 1/3 of the deviation can be corrected by prism stimulation and fusion. Recently, some people have proposed that patching is a good non-surgical treatment method for intermittent exotropia in the early stage. With this method of treatment, about 40% of patients can change their manifest strabismus (looking at the distance) into latent strabismus. In the early stage of intermittent exotropia, surgical treatment is not recommended because it is latent exotropia most of the time, the number of manifest exotropia is not frequent, and the deviation is not large.