Treatment of consecutive exotropia: unilateral lateral rectus recession combined with medial rectus advancement or resection.

Purpose: Consecutive exotropia presents a difficult clinical problem, especially when previously recessed medial recti are to be strengthened. Surgical options include advancement, typically with a small resection, and resection alone.

Methods: The authors retrospectively reviewed records of all patients who underwent a second two-muscle surgery on a single eye for consecutive exotropia. Patients with paralytic strabismus and those with less than 1 month of postoperative follow-up were excluded. In 2003, one of the authors began medial rectus resections without advancements in most cases, whereas a second author continued to perform advancements. Two treatment groups were thus reviewed.

Results: Forty-two patients qualified for inclusion, including 23 for the resection group and 19 for the advancement group. Preoperative deviations were similar (P = .35, 95% confidence interval: -2.64 to 9.82). Postoperative deviations averaged 11.4 prism diopters (PD) in the resection group and 11.5 PD in the advancement group (P = .98, 95% confidence interval: -12.2 to 12.3). Forty-eight percent of the resection group and 63% of the advancement group achieved alignment within 10 PD of orthophoria (P = .33, 95% confidence interval: -9.0% to 39%).

Conclusions: Surgical results were favorable following both techniques. Although both techniques appear to be adequate, resection of previously recessed medial recti may be preferable because they allow use of standard surgical tables and avoid advancement of inflamed tissue into the palpebral fissure.