Surgical Management of Consecutive Exotropia : Surgical Choice Based on the Angle of Deviation

Consecutive exotropia is an outward ocular deviation that develops following previous surgical correction of esotropia. It may occur early after surgery or develop gradually over time and can be associated with cosmetic concerns, impaired binocular function, and symptomatic diplopia. The development of consecutive exotropia may be related to several factors, including the degree of previous surgical correction, reduced medial rectus muscle function, mechanical or restrictive changes, and other patient-related factors.

The surgical management of consecutive exotropia remains variable and is generally individualized according to the magnitude of the postoperative deviation, the status of the previously operated medial rectus muscles, and the surgical history. Common surgical approaches include lateral rectus recession, medial rectus advancement, or a combination of medial rectus advancement and lateral rectus recession. However, a practical surgical strategy based primarily on the magnitude of the angle of deviation may facilitate surgical planning in patients with consecutive exotropia following a single previous operation for esotropia.

This retrospective study evaluates a surgical management strategy in which the surgical procedure is selected according to the preoperative angle of consecutive exotropia. Patients with a deviation of 30 prism diopters (PD) or less are managed with bilateral lateral rectus recession. Patients with a deviation greater than 30 PD are managed with advancement of one or both previously recessed medial rectus muscles, with or without unilateral or bilateral lateral rectus recession according to the magnitude of the deviation.

The study will assess postoperative ocular alignment and clinical outcomes following this angle-based surgical approach. Postoperative assessments will be performed at predefined follow-up visits to evaluate the stability of ocular alignment and identify postoperative complications or recurrent deviation.

The primary purpose of the study is to evaluate whether selection of the surgical procedure according to the magnitude of the preoperative angle provides a practical approach for the surgical management of consecutive exotropia. The findings may help characterize the postoperative alignment achieved with the different surgical approaches and provide clinical information regarding the applicability of an angle-based surgical strategy in patients with consecutive exotropia after previous esotropia surgery.