A 7-year-old child is found to have an intermittent exotropia of 20 prism diopters at distance and 10 prism diopters at near, with good stereopsis and no amblyopia. The most appropriate initial management is:

• A Immediate bilateral lateral rectus recession
• B Overminus lens therapy
• C Botulinum toxin injection to the lateral rectus
• D Observation and part-time occlusion of one eye ✓

Explanation

For intermittent exotropia with good control, good stereopsis, and no amblyopia, observation with part-time occlusion of either eye is the recommended initial management. Overtime, the deviation may remain stable. Surgery is reserved for deterioration in control or loss of stereopsis. Overminus lenses are sometimes used but are not first-line. Botulinum toxin is less commonly used in pediatric exotropia.

Reference: Pediatric Ophthalmology and Strabismus, AAO BCSC, 2023-2024 ed.

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Written and medically reviewed by the StethoPrep medical team.