In the surgical correction of a large-angle divergent strabismus (exotropia > 35 prism diopters), the preferred surgical approach is:

• A Bilateral medial rectus resection alone
• B Unilateral lateral rectus recession combined with medial rectus resection (R&R procedure)
• C Bilateral lateral rectus recession combined with unilateral medial rectus resection ✓
• D Unilateral lateral rectus recession alone in the non-dominant eye

Explanation

For large-angle exotropia (> 30-35 prism diopters), the surgical approach requires operating on 3 or more muscles. Bilateral lateral rectus recession (BLRT) alone corrects approximately 25-30 PD maximum. For larger deviations, BLRT combined with unilateral medial rectus resection allows correction of 40-50+ PD. The unilateral R&R (recession-resection) approach on one eye corrects up to approximately 25 PD per eye (combining 5 mm LR recession + 5 mm MR resection on the same eye), suitable for deviations of 20-30 PD. Bilateral MR resection alone would worsen convergence insufficiency and is inappropriate for exotropia. The choice depends on whether the deviation is constant vs. intermittent, amblyopia status, and near-distance differences.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.