Exotropia: Causes, Symptoms, Diagnosis, and Treatment Options

Exotropia is a form of strabismus, or eye misalignment, in which one eye turns outward away from the other eye. It is a relatively common condition that can occur in both children and adults, and may be present all the time or only intermittently. Exotropia is caused by a disruption in the normal control of eye movement, which can occur due to a variety of factors. Our optometrists are trained to diagnose and manage exotropia, and can help patients with this condition to achieve better eye alignment and improved vision.

Exotropia: Causes, Symptoms, Diagnosis, and Treatment Options in Olympia

How common is Exotropia?

A 2019 meta analysis estimated the global prevalence of exotropia at 1.23%. While a major population based study of 5800 preschool students in China showed a prevalence of 3.24%. 

American Family Vision Clinic

Understanding Exotropia: Symptoms and Impact on Your Vision

Exotropia can cause a wide range of symptoms that can affect the patient's vision, daily activities, and self-confidence. Take our online visual skills assessment to help identify if you or your child has a potential visual deficit that may be interfering with success in the classroom, work, or sports /vision-therapy-specialty/vision-and-learning-quiz/ 

Here are some common symptoms of exotropia that patients may experience: 

Eye misalignment: In exotropia, one or both eyes turn outward, causing the eyes to be misaligned. This can result in a noticeable cosmetic defect, making the individual appear as if they are looking in two different directions. Eye misalignment can also cause many of the symptoms listed below. 

Double vision: Exotropia can lead to the development of double vision or diplopia. This occurs when the eyes are unable to fuse the images from both eyes into a single image, causing the patient to see two images of the same object. Take our online double vision assessment to help identify if you may have an underlying vision problem that is causing diplopia (double vision) /neuro/double-vision-quiz/ 

Eye fatigue: Patients with exotropia may experience eye fatigue due to the constant effort required to align their eyes. This can cause headaches, eyestrain, and difficulty reading or focusing for extended periods.

Loss of depth perception: Exotropia can also lead to a loss of depth perception or the ability to judge the distance between objects accurately. This can affect the patient's ability to engage in activities such as sports, driving or operating machinery.

Head tilting or turning: To compensate for the misalignment of their eyes, patients with exotropia may develop the habit of tilting or turning their heads in an attempt to align their eyes. This can lead to neck pain or discomfort.

Squinting or closing one eye: In some cases, individuals with exotropia may squint or close one eye to avoid double vision or to align their eyes. This can cause the affected eye to become weak or lazy, leading to a condition known as amblyopia.

Poor eye contact: Exotropia can also cause patients to avoid eye contact or maintain eye contact with others due to the embarrassment of having a visible cosmetic defect. This can lead to social isolation or a lack of self-confidence.

Eye strain and discomfort: Patients with exotropia may experience eye strain or discomfort due to the misalignment of their eyes. This can be particularly noticeable when trying to focus on near objects.

Fatigue: Patients with exotropia may feel fatigued, particularly after extended periods of reading, writing, using a phone or computer, or other visually demanding activities.

Sensitivity to light: Patients with exotropia may be more sensitive to bright lights or glare, particularly when the eyes are misaligned.

Difficulty with night vision: Patients with exotropia may experience difficulty with night vision, particularly when driving.

If you or someone you know is experiencing any of these symptoms, it is important to seek the help of our functional optometrist. A functional eye exam can help diagnose exotropia and other vision problems, leading to early intervention and management of the condition. Please call at (360) 491-2121 to schedule a functional eye exam.

Uncovering the Root of Exotropia: What Causes Exotropia?

While exotropia can be easily noticeable, the underlying causes can be complex and varied. Here are some of the causes of exotropia that we have observed at our optometry clinic:

Weak Eye Muscles: Our eye muscles play a vital role in controlling eye movements and alignment. Weak or imbalanced eye muscles can lead to exotropia, where one eye drifts outward. This may happen due to several reasons, such as genetics, trauma, or neurological disorders.

Refractive Errors: Refractive errors occur when the shape of the eye causes light to focus incorrectly, leading to blurred vision. If one eye has a significant refractive error, the brain may start suppressing the vision of that eye, leading to exotropia.

Neurological Conditions: Several neurological conditions can lead to exotropia. Some of these conditions affect the nerves that control eye movements, while others affect the brain regions that process visual information. Neurological causes of exotropia may include brain tumors, stroke, multiple sclerosis, and cerebral palsy.

Genetics: Exotropia can also have a hereditary component, where certain genes can increase the risk of developing the condition. Studies have shown that exotropia is more common in families with a history of the condition.

Eye Injuries: Trauma to the eye or surrounding areas can cause exotropia. For example, a blow to the head can damage the eye muscles or nerves, leading to a misalignment of the eyes. Additionally, some surgeries involving the eyes or nearby structures can cause exotropia.

Systemic Diseases: Some systemic diseases, such as diabetes or thyroid disorders, can also cause exotropia. These conditions may affect the eye muscles or nerves, leading to eye misalignment.

Medications: Certain medications can cause exotropia as a side effect. For example, some drugs used to treat seizures, psychiatric conditions, or allergies can affect the eye muscles or nerves, leading to exotropia.

Amblyopia: Amblyopia, also known as lazy eye, is a condition where the brain suppresses the vision of one eye to avoid double vision. If this suppression is not treated, it can lead to exotropia in the affected eye.

Stress or Fatigue: Sometimes,exotropia can occur due to fatigue or stress. When the eye muscles become tired, they may not be able to maintain proper alignment, leading to outward deviation of the eyes.

Idiopathic: In some cases, exotropia may occur for no apparent reason. This is called idiopathic exotropia and is more common in children. Idiopathic exotropia may be related to the development of the visual system and may resolve with age.

Psychological Factors: Psychological factors, such as anxiety or stress, can also lead to exotropia. These factors may affect the control of the eye muscles, leading to outward deviation of the eyes.

Neuro Diverse: The incidence of exotropia is significantly higher within the neuro diverse population such as those with down syndrome, ADD/ADHD, cerebral palsy, and Autism. 

Uncovering the Root of Exotropia: What Causes Exotropia?
Diagnosing Exotropia: How Functional Optometrists Diagnose this Vision Condition

Diagnosing Exotropia: How Functional Optometrists Diagnose this Vision Condition

Diagnosing exotropia involves a comprehensive eye examination, including a detailed patient history and various clinical tests. Optometrists that specialize in functional vision perform a more in depth examination if symptoms or signs of exotropia exist. Some of the diagnostic tests we would perform include:

Cover test: This test involves covering one eye at a time to observe the eye's movement and any deviation when it's uncovered. It can help to identify whether the eye turns outward when uncovered, indicating exotropia.

Ocular motility exam: This exam evaluates the movement and alignment of the eyes when following an object. It can help to identify the type and severity of exotropia.

Refraction test: This test measures your visual acuity and any refractive errors that may be causing exotropia or exacerbating the condition.

Binocular vision assessment: This exam evaluates your ability to use both eyes together and can help to determine the level of binocular vision impairment caused by exotropia.

Hirschberg test: This is a screening test that uses a light to assess the position of the eyes. The test is performed by shining a light in your eyes and observing the reflection of the light on the cornea. If the reflection is not centered, it may indicate that the eye is deviated and exotropia may be present.

Krimsky test: This test is similar to the Hirschberg test but involves using prisms to determine the angle of deviation.

Maddox rod test: This test uses a special lens called a Maddox rod to determine the angle of deviation and the direction of the eye's movement.

Worth 4-Dot test: This test evaluates your binocular vision and can help to determine the severity of the exotropia.

Stereopsis test: This test evaluates your ability to perceive depth and can help to assess the level of binocular vision impairment caused by exotropia.

In addition to these tests, we may also assess your overall eye health and rule out any underlying conditions that may be contributing to exotropia.

Diagnosing Exotropia: How Functional Optometrists Diagnose this Vision Condition

Treating Exotropia: A Comprehensive Guide to Management and Care

There are several management and treatment options that can help improve this condition.

Vision therapy: One of the main ways that vision therapy can improve exotropia is by strengthening the muscles that control eye movements. By using exercises that target specific muscle groups, we can help patients to gain better control over their eye movements, reducing the frequency and severity of exotropia. Another key component of vision therapy is improving eye coordination, which is essential for maintaining binocular vision and avoiding double vision. By using techniques such as convergence exercises and prism lenses, vision therapists under the direction of a functional optometrist can help to improve the ability of the eyes to work together, reducing the strain and discomfort associated with exotropia. Learn more about vision therapy here /about-us-practice-page/our-specialty/vision-therapy-specialty.

Surgery: For patients who have a more severe or constant exotropia, surgery may be recommended. During the procedure, the muscles responsible for eye movement are adjusted to help realign the eyes. The surgery is typically performed on an outpatient basis, and most patients are able to resume normal activities within a few days. In many cases surgery is done in combination with vision therapy to achieve optimal results. 

Patching: One of the main ways that patching can improve exotropia is by addressing the underlying causes of the condition. Exotropia often results from a weaker eye, which may have a refractive error, amblyopia, or other issues. By patching the dominant eye, the weaker eye is forced to work harder, which can lead to improved visual acuity, visual perception, and other visual skills. Over time, this can help to correct the imbalance between the eyes and reduce the frequency and severity of exotropia.

Another way that patching can improve exotropia is by promoting better binocular vision. When the two eyes work together effectively, the brain receives a single, clear image, reducing the likelihood of double vision and other problems associated with exotropia. By stimulating the weaker eye and improving its visual skills, patching can help to promote better binocular vision and reduce the strain and discomfort associated with exotropia. In most cases patching is done in combination with in-office vision therapy to reintegrate the binocular vision system. 

Eye drops: Some patients may benefit from using eye drops, such as atropine, which can help to relax the muscles responsible for eye movement. This can be a particularly effective option for patients who have a mild or intermittent exotropia.

Botox injections: Botox injections can be used to help weaken the muscles responsible for eye movement, which can help to improve eye alignment. This can be a particularly effective option for patients who have a more severe or constant exotropia.

Prism lenses: For some patients, prism lenses may be a viable option. Prism lenses are prescription lenses that can be used to help align the eyes, allowing them to work together to produce a clear image.

It's important to note that the appropriate management and treatment for exotropia can vary depending on the individual patient's case. It's crucial for our optometrists to work closely with you to identify the most appropriate treatment options to improve visual function and quality of life.

Dr. Zurcher cartoon

Schedule a functional eye exam in Olympia for exotropia

If you or a loved one are experiencing symptoms of exotropia, don't hesitate to schedule an appointment with our experienced optometrists for a functional eye exam. Our team will work with you to develop a personalized treatment plan that is tailored to your specific needs and goals. 

No matter the size of your exotropia angle, we can help manage and deal with it. Schedule a functional or developmental eye exam with our optometrist at American Family Vision Clinic by calling (360) 491-2121. Our clinic welcomes patients with eye alignment issues, like exotropia, from all over Washington. We are a leading provider of functional vision and vision therapy services for patients in Olympia, Lakewood, Tacoma, and Lacey.


Such a nice optician. My grandson is only 4 and needs glasses. We were so sad, but he explained the issues, and we will follow up as he suggested.

Anna P.

I had such a good experience with the clinic. Very friendly staff and doctor, did not have to wait for long to be called, and was treated respectfully. Thanks, American Family.

June S.

Dr. Zurcher has gone above and beyond what any other eye doctor has ever done to figure out what is going on with my eyes. Very happy with American Family Vision.

Christine R.

Family Vision Clinic changed our lives! My daughter was frequently car sick, and she was getting headaches every day, often painful enough that they brought her to tears. We saw a string of doctors and therapists, but we made no progress. Finally, we found Dr. Levi Zurcher and his eye therapist Rain. After ten weeks of eye therapy my daughter no longer gets headaches, and she no longer gets car sick. Daily tears are a thing of the past. I really can’t say enough about this clinic. It was fascinating to watch Dr. Zurcher work. For the first time, someone who knew what they were doing was intently studying my daughter, really trying to figure out all of her eye issues, and his therapist Rain is one of the most patient and lovely people that I’ve ever had the good fortune to meet. We’re finished with eye therapy—yay!—and I have switched to American Family Vision Clinic for all of my family’s other eye health needs.

Lars Wulff

Very professional, yet kind and helpful. They do what they can to make the appointment comfortable. I was running a bit late, I made sure ti call. They were able to switch me with a patient who was already there, they treated me with respect, and helped my son have confidence by getting him the eye care he needed that day. Thank you so much! Would recommend to anyone. It's a blessing that they care enough to work with people who have all different types of insurance from work to state coverage.

Justin E.

The staff is friendly. The Doc is very knowledgeable. The office is family friendly and everyone is so patient with the little ones.

Amy Fagerness
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