title: Conservative management of intermittent distance exotropia: a review.
abstract: OBJECTIVE
  Intermittent distance exotropia is difficult to conservatively manage, with techniques varying widely between institutions. This review aims to examine current literature on conservative management for intermittent distance exotropia, investigate its impact upon current clinical practice, and identify areas for further research.
  
  
  METHODS
  A literature search was performed using PubMed, Web of Knowledge, LILACS, and the University of Liverpool Orthoptic Journals and Conference Transactions Database. All English-language papers published between 1950 and the present day were considered.
  
  
  RESULTS
  Intermittent distance exotropia is a difficult condition to manage because of its variability / uncertain natural history, although control scores can facilitate management decisions. Research is required to establish recommended dosages for antisuppression occlusion and determine whether other treatments such as minus lenses are more effective. Use of orthoptic exercises has declined, but recently certain exercises have been shown to improve surgical outcomes if applied preoperatively. Prisms are mainly used postoperatively. Minus lens therapy is recommended as a first line treatment, but may not always be successful.
  
  
  CONCLUSIONS
  Conservative management techniques for intermittent distance exotropia have their place as both an alternative and an adjunct to surgery. However, further research needs to be conducted to determine which techniques are appropriate for which patients.
authors.affiliation: Directorate of Orthoptics and Vision Science, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Marianne
authors.initials: M
authors.lastname: Piano
authors.forename: Anna R
authors.initials: AR
authors.lastname: O'Connor
mesh_terms: D005099:Exotropia / Q000503:physiopathology / Q000628:therapy*; D005139:Eyeglasses; D006801:Humans; D009801:Oculomotor Muscles / Q000503:physiopathology; D013508:Ophthalmologic Surgical Procedures; D009988:Orthoptics / Q000379:methods