Exotropia in Children with High Hyperopia

Introduction: This study describes the uncommon association of exotropia in children with high hyperopia. Methods: We retrospectively reviewed the charts of 26 patients seen by our pediatric ophthalmology service between 1990 and 2009 who had an exotropia and 4.00 or more diopters of hyperopia. We analyzed the characteristics of our patient population as well as alignment outcomes with full or partial hyperopic correction. Results: Twenty-six patients between the ages of 2.5 months and 9 years met study criteria. Fifteen patients in this study had associated medical conditions or developmental delay. Nineteen of 22 patients with measured visual acuities had amblyopia, 10 of which were unilateral and 9 bilateral. Patients also had poor stereopsis, with none demonstrating fine stereoacuity. Twenty-three exotropic children were treated with spectacles. Fifteen children received their full cycloplegic refraction and 10 of these children had improvement in their exotropia. Eight children received partial correction of their hyperopia and only 3 had improvement in their exotropia. Six of 26 patients required strabismus surgery and presented with large poorly-controlled exotropia or no improvement with spectacle correction. Conclusions: Children with high hyperopia and exotropia are likely to have developmental delay or other systemic diseases, amblyopia, and poor stereopsis. Treatment of high hyperopia in exotropic children with their full cycloplegic refraction can result in excellent alignment. Poor alignment with need for strabismus surgery was associated with an initial large angle, poorly controlled exotropia, and poor response to spectacles.