Consecutive exotropia refers to a manifest exodeviation following surgery to correct esotropia. Surgery is common for early onset esotropia, particularly congenital/infantile esotropia. Congenital/infantile esotropia is usually accompanied by several ocular phenomena, including: latent nystagmus, dissociated vertical deviation (DVD) and overaction of the extraocular muscles, especially the inferior obliques. Additionally, since there is a disturbance in normal binocular vision, anomalous correspondence (AC) is often present. Despite this poor or limited binocularity, interventions to increase fusional ability are possible and should be considered.
This is the case of a 28-month-old child who presented to us with anisometropia, amblyopia and a partially accommodative esotropia. The latter condition was subsequently surgically altered, resulting in a consecutive exotropia. The patient's anisometropia decreased following a regimen of full spectacle correction, occlusion (direct patching) and vision therapy. The reduction of anisometropia coincided with the improvement of binocularity and visual acuity. A discussion of the relationship among the development of anisometropia, amblyopia, esotropia and consecutive exotropia is presented.