• Reference Number: HEY1150/2023
• Departments: Ophthalmology Department
• Last Updated: 31 December 2023

Introduction

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is Intermittent Distance Exotropia?

A number of different types of subcategory of squints exist. Intermittent distance exotropia is a specific type of squint (strabismus). With this type of squint when an individual looks beyond 3 meters, one eye turns outwards towards the ear. The squint may be constant or intermittent on distance viewing. You may find it is more noticeable when your child is tired, unwell or daydreaming. When the eye turns out some children occasionally close their eye, particularly in bright sunlight. Most children are able to keep their eyes straight and working together when they carry out near tasks such as reading.

What is the cause of Intermittent Distance Exotropia?

Intermittent distance exotropia is the result of an imbalance of the eye muscles. Everyone has a level of control over their eyes, however if the imbalance is too great it can become too difficult to keep the eyes under control, particularly in the distance. Occasionally there can be family history of this type of squint but this is limited to immediate family.

Can this impact vision and why do I need to attend appointments?

Children are not born with fully developed vision; in the same way they learn to speak they have to learn to see. Children with intermittent distance exotropia usually are not at risk of amblyopia (lazy eye), as there are times when both eyes receive appropriate visual stimulus. You may notice your child rubbing or closing one eye (usually the eye that squints), particularly in bright sunlight. It is rare for young children to notice symptoms such as double vision with this condition.

If your child is thought to have intermittent distance exotropia, their focussing will be checked and glasses will be prescribed, if required. Your child will be advised to wear the glasses for all waking hours. Regardless of whether glasses have been prescribed or not you will be invited for a follow-up appointment. At this appointment the future management of your child’s condition will be discussed in more detail.

Generally the options to manage this type of squint fall into the following categories:

• No formal treatment but continue monitoring the squint
• The use of spectacles
• Orthoptic exercises in combination with spectacles
• Squint surgery

All treatment options are there to encourage and maintain your child’s vision and depth perception (3D vision). Your appointments with the Orthoptic Team will guide the management plan for your child, which may change dependent on your child’s control of their squint. Not all options work for all children.

Are there any complications or risks?

Generally this type of squint poses a relatively low risk to your child’s visual development due to its intermittent nature. Some children however may develop amblyopia (lazy eye) and as a result require treatment (amblyopia therapy). There is a risk that the squint may deteriorate over time and become constant; regular visits with the Orthoptic Team will monitor this.

The treatments available allow a range of options to be considered. All treatment options have their advantages and disadvantages and these will be discussed with you at your child’s appointment.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Orthoptic Department on tel: 01482 816605.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats your child, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to your child. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your child’s condition, the alternatives available for your child, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about your child

We collect and use your child’s information to provide your child with care and treatment. As part of your child’s care, information about your child will be shared between members of a healthcare team, some of whom you may not meet. Your child’s information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide your child with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your child’s doctor, or the person caring for your child.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about your child. For further information visit the following page: Confidential Information about You.

If you need information about your child’s (or a child you care for) health and wellbeing and their care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.