Bilateral Occlusion Reduces the Ocular Deviation in Intermittent Exotropia.

Invest Ophthalmol Vis Sci

Department of Ophthalmology, Program in Neuroscience, University of California, San Francisco, San Francisco, California, United States.

Published: January 2021

AI Article Synopsis

  • The study investigates intermittent exotropia, a common eye condition, by analyzing how eye alignment changes under one-eye (monocular) and both-eyes (binocular) occlusion.
  • Eighteen patients were observed using video eye trackers; results showed a significant reduction in eye deviation when both eyes were occluded compared to one eye, indicating a 56% decrease in ocular misalignment.
  • The findings suggest that visual feedback from the fixating eye plays a crucial role in maintaining eye alignment, as the deviation was lower when both eyes were covered and reverted immediately when vision was restored.

Article Abstract

Purpose: The most common form of strabismus, intermittent exotropia, is thought to become manifest when the drive to fuse is overcome by excessive divergent muscle tone. This principle is tested by examining the alignment of the eyes in the absence of vision. We compare the ocular deviation in patients with intermittent exotropia under conditions of monocular versus binocular occlusion.

Methods: This prospective study of a patient cohort referred to our laboratory enrolled 18 patients with typical findings of well-controlled intermittent exotropia. Eye positions were recorded with video eye trackers while patients looked at a fixation spot at a distance of 57 cm. One eye was occluded, and the resulting ocular deviation was measured. Both eyes were then occluded, and the ocular deviation was re-measured.

Results: The majority of patients (11/18) had a smaller deviation when both eyes were covered. Occlusion of one eye resulted in a mean exotropia of 13.5° ± 4.7°. Occlusion of both eyes reduced the mean exotropia to 6.0° ± 6.5° (paired t-test, P < 0.001), corresponding to a 56% reduction in the ocular deviation. This reduction persisted during prolonged bilateral occlusion but reversed as soon as vision was restored.

Conclusions: Bilateral occlusion reveals a fixation-free state of alignment that is different from orthotropia and usually less than the exotropia that occurs spontaneously during binocular viewing. This finding demonstrates that the deviation angle in patients with intermittent exotropia is actively mediated by visual feedback, which the fixating eye is capable of providing alone.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7794258PMC
http://dx.doi.org/10.1167/iovs.62.1.6DOI Listing

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