This document discusses exodeviations, which are eye misalignments where one or both eyes turn outward. It classifies exodeviations as comitant or incomitant, and as congenital, primary, or secondary. Primary exodeviations develop from predisposing mechanical or innervational factors and progress through latent, intermittent, and constant stages. Secondary exodeviations are sensory or consecutive types. Specific types discussed include congenital exotropia, divergence excess exotropia, paralytic exotropia, and restrictive exotropia. Treatment options vary depending on the type and stage of exodeviation.

1. TOPIC: EXODEVIATIONS
NAME: NAMRATA GIRKAR
ROLL NO.: PARB-OPT1F004
SUBJECT CODE: ITMU-OPT 307
SUBJECT: BINOCULAR VISION II
COLLEGE: ITM UNIVERSITY
BRANCH: PAREL.

2. WHAT ARE EXO-DEVIATIONS
?
Normal eye alignment with
image falling on both foveas.
Both eyes are fixating
and the image is falling
temporal to the left fovea.
Both eyes are fixating and
the image is falling
temporal to the right fovea.

3. CLASSIFICATION:
COMITANCE INCOMITANCE
CONGENITAL
PRIMAR
Y
SECONDARY
BASIC
DIVERGENCE
EXCESS
PSEUDO
EXOTROPIA
CONVERGENCE
INSUFFICIENCY
SENSORY
CONSECUTIVE PARALYTIC
A , V and X
PATTERN
SPECIAL
TYPES OF
RESTRICTIVE

4. A. CONGENITAL EXOTROPIA :
 ASSOCIATION
 CHARACTERISTIC FEATURES
 DIFFERENTIAL DIAGNOSIS
 TREATMENT
COMITANT STRABISMUS

5. B. PRIMARY EXOTROPIA :
ETIOLOGY:
1. PRE-DISPOSING FACTORS
• Mechanical Factors
• Innervational Factors
STAGES OF DEVELOPMENT OF EXO-DEVIATION:
1. STAGE OF LATENT EXO-DEVIATION
• Convergence Weakness Type
• Divergence Excess Type

6. 2. STAGE OF INTERMITTENT EXO-TROPIA
 CLINICAL FEATURES
1. Precipitating Factors
2. Symptoms
• Transient Diplopia
• Asthenopic Symptoms
• Deviation
 SENSORY ADAPTATIONS

7.  CLINICAL EVALUATION:
1. History Taking
2. Visual Acuity

8. 3. Cyclopegic refraction
4. Cover test

9. 5. Measurement of Deviation
• Prism and Alternate Cover Test ( Prism Bar Cover Test , i.e. PBCT )

10. 7. +3.00D Spherical Lens Test
6. Occlusion Test
 TREATMENT:
1. Optical Treatment
2. Prismotherapy
3. Orthoptic Treatment
4. Surgical Treatment

11. 3. STAGE OF CONSTANT EXO-DEVIATION
 CLINICAL FEATURES
1. Time of onset
2. Fixation Pattern
• Alternating Exotropia
• Unilateral Exotropia
 ASSOCIATIONS
 TREATMENT

12.  DUANE'S CLASSIFICATION OF EXO-TROPIA:
1. BASIC EXOTROPIA

13. 2. DIVERGENCE EXCESS EXOTROPIA

14. 3. PSEUDO EXO-TROPIA

15. 4. CONVERGENCE INSUFFICIENCY EXO-TROPIA

16. C. SECONDARY EXOTROPIA
1. SENSORY EXOTROPIA

17. 2. CONSECUTIVE EXOTROPIA

18. INCOMITANT STRABISMUS
A. PARALYTIC EXOTROPIA :
1. ISOLATED MEDIAL RECTUS PARESIS
2. COMPLETE THIRD NERVE PARALYSIS
3. PARALYSIS OF CONVERGENCE
B. A ,V AND X PATTTERN EXOTROPIA :

19. C. SPECIAL TYPES OF RESTRICTIVE EXO-TROPIA:
1.DUANE'S RETRACTION SYNDROME ( TYPE 2 )
2. CRANIOFACIAL ANOMALIES WITH DIVERGENT ORBIT
3. THYROID MYOPATHY
4. DISASSOCIATED HORIZONTAL DEVIATION

20. REFERENCE:
 Theory and Practice of Squint and Orthoptics (Second Edition) : A.K. Khurana
 Binocular Vision and Ocular Motility (Sixth Edition ): Gunter K. von Noorden
 Strabismus Simplified ( Second Edition) : Pradeep Sharma
 Handbook of Pediatric Strabismus and Amblyopia ( First Edition): Kenneth W. Wright
 Pediatric Ophthalmology and Strabismus (Section 6) : American Academy of Ophthalmology
 Clinical Ophthalmology: A Systemic Approach (5th ,6th ,7th Edition): Jack J. Kanski
Websites:
 https://www.pubmed.com
 https://www.googlescholar.com
 https://www.ncbi.nlm.nih.gov
 https://www.sciencedirect.com