Exotropia: Why an Eye Turns Outward and What Treatment Options Look Like
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer
Exotropia is a form of strabismus in which one or both eyes turn outward, toward the ears. When one eye turns out it's called monocular exotropia; when both do, it's bilateral exotropia. It's most common in babies and children, can also affect adults, and is best treated as early as possible to protect vision, depth perception, and self-esteem.
What the research says
There is no single agreed best treatment for intermittent exotropia, and the evidence for each option differs. A review of the non-surgical and surgical options found that randomized trial data support observation and patching as reasonable choices for children aged 3 to 10, that overminus lenses improved control only while the glasses were worn, that base-in prism was no more effective than regular glasses, and that vision therapy (orthoptics) beat observation alone. Surgery changed several clinical measures, but no randomized trial has compared it with a no-treatment group (PubMed: Ma and Scheiman, Strabismus, 2024 [2]).
Both surgery and non-surgical care can improve eye alignment, but results depend on the child. A systematic review of 13 studies (sample sizes 40 to 306) found that surgical and non-surgical treatments both improved motor alignment and binocular function, with the size and durability of success depending on age, treatment compliance, the size of the deviation, and timing (PubMed: Almadani et al., Cureus, 2026 [3]).
What Is Exotropia?
Exotropia is a form of strabismus, a misalignment of the eyes. If you have exotropia, one or both of your eyes turn outward (toward your ears). Exotropia (pronounced "ek-suh-TROH-pee-uh") is the opposite of esotropia, the turning inward of your eyes. While it's commonly seen in babies and children, it can also affect adults [1].
If you notice your child's eye turning out, it's important to seek treatment right away. The eye with exotropia can have vision problems, and the appearance of the condition can lead to low self-esteem and issues with social development. The sooner your child receives a diagnosis, the sooner they can begin treatment to correct the alignment of their eyes [1].
Key point | What it means |
Definition | A form of strabismus in which one or both eyes turn outward (toward the ears) |
Direction | The opposite of esotropia (inward-turning eyes) |
One or both eyes | Monocular (one eye) or bilateral (both eyes) |
Most common in | Babies and children; can also affect adults |
Common type | Intermittent — comes and goes |
If untreated | Can progress to constant exotropia, amblyopia, lost depth perception |
Best approach | Treat as early as possible |
How do you know if it's one eye or both?
In monocular exotropia, the turning involves one eye. In bilateral exotropia, the turning affects both eyes [1].
The Six Types of Exotropia
There are many types of exotropia, including intermittent, constant, infantile (congenital), sensory, alternating, and consecutive (secondary) [1].
Type | How it behaves |
Intermittent exotropia | Most common form; not present all the time — comes and goes. The eye may turn outward when tired, sick, or under stress |
Constant exotropia | Eye or eyes always turn outward away from the nose, at near or far distances; less common than intermittent |
Infantile (congenital) exotropia | Present at birth or from early infancy |
Sensory exotropia | Occurs in an eye that already doesn't see well; the poor-vision eye turns out because it can't work with the other eye |
Alternating exotropia | Happens in each eye at different times (different from unilateral exotropia, where the same eye always turns out) |
Consecutive (secondary) exotropia | A misalignment that happens after surgery to treat esotropia |
Symptoms of Exotropia
The signs and symptoms of exotropia include eyes turned outward some or all of the time, squinting, eye strain, headaches, double vision (diplopia), closing one eye when you're in bright sunlight, and decreased depth perception [1]. Notably, exotropia is not always obvious to the person who has it — often a parent or provider notices first [1].
Sign or symptom | What you might notice |
Outward-turned eye | Eye turned out some or all of the time |
Squinting | Frequent squinting |
Eye strain | Tired, strained-feeling eyes |
Headaches | Recurring headaches |
Double vision | Diplopia |
Light sensitivity | Closing one eye in bright sunlight |
Depth perception | Decreased depth perception |
What Causes Exotropia?
Exotropia has many possible causes, including genetics, eye muscle weakness, convergence insufficiency (CI), nervous system conditions, and extremely poor vision. Genetics play a role because strabismus runs in some biological families. Eye muscle weakness occurs when your eye muscles can't control your eye movements. With convergence insufficiency, your eyes don't come together at the right point to see an object nearby. Health conditions like stroke or tumors can cause exotropia. Having low vision in your eye can cause exotropia too. And especially with intermittent exotropia, sometimes there is no known cause [1].
Cause | How it leads to exotropia |
Genetics | Strabismus runs in some biological families |
Eye muscle weakness | Eye muscles can't control eye movements |
Convergence insufficiency (CI) | Eyes don't come together at the right point to see nearby objects |
Nervous system conditions | Stroke or tumors can cause exotropia |
Extremely poor vision | Low vision in one eye can cause it to turn out |
Unknown (idiopathic) | Intermittent exotropia sometimes has no known cause |
What are the risk factors for exotropia?
The risk factors for developing exotropia include neurologic disorders, preterm birth, substance and alcohol use during pregnancy, genetic variations, uncorrected refractive errors, and a biological family history of strabismus [1].
Risk factor | Why it matters |
Neurologic disorders | Can affect eye-muscle control |
Preterm birth | Increases strabismus risk |
Substance/alcohol use during pregnancy | Increases strabismus risk |
Genetic variations | Inherited predisposition |
Uncorrected refractive errors | Focus problems strain alignment |
Family history of strabismus | Strabismus runs in some families |
What Are the Complications of Exotropia?
Left untreated, intermittent exotropia can progress to constant exotropia. As the condition progresses at a young age, your child may experience amblyopia (lazy eye) or the loss of binocular vision — both eyes working together to see. Untreated exotropia can also lead to amblyopia, poor vision in one eye. Without treatment, you may lose your ability to see with both eyes (binocular vision) and have difficulty with your depth perception [1].
How Is Exotropia Diagnosed?
You or your healthcare provider may notice that your child's eyes are turning outward. It's not always obvious to the person who has exotropia. They may refer you to an ophthalmologist or optometrist. Your child's provider will ask for a family and medical history and will perform an eye exam that covers how your child's eyes move and focus [1].
Test | What it does |
Family and medical history | Identifies genetics and underlying conditions |
Visual acuity test | Reading letters from an eye chart; young children's visual behavior |
Refraction test | Corrective lenses measure how the eyes focus light (no verbal feedback needed) |
Alignment and focus tests | Check how well the eyes line up and see clearly |
Exam after dilation | Pupils widened to check the health of internal eye structures |
Treatment for Exotropia
Treatment of exotropia varies depending on the severity of the condition. Sometimes, intermittent exotropia stays mild or goes away on its own [1].
Treatment | How it works | Best for |
Eye patching | Patch over the stronger eye so the weaker eye gets stronger | Amblyopia risk |
Eye drops | Work like a medical form of patching | Children who resist patches |
Corrective lenses | Eyeglasses or contact lenses | Refractive errors |
Visual therapy | Eye exercises for alignment | Convergence insufficiency |
Botulinum toxin (Botox) | Injections into eye muscles help realignment | Selected cases |
Surgery | Tighten or loosen muscles in one or both eyes | Persistent or constant exotropia |
Outlook: What to Expect
What is the outlook for people with exotropia?
Exotropia may become less frequent over time, but most types don't resolve completely. Treatment with nonsurgical measures may help control the condition, but many people still experience recurrences [1].
Does exotropia get worse with age?
Exotropia can get worse over time if it's not treated, although in many children intermittent exotropia stays stable or even improves. You can manage it, but it may never go completely away. Some researchers believe that the permanent answer to the problem of intermittent exotropia lies in being able to repair the brain, which isn't currently possible [1].
Can exotropia be prevented?
You can't prevent exotropia. If you're pregnant or planning to become pregnant, you may wish to speak with a genetic counselor about your risk of passing on the condition to your child [1].
Living With Exotropia
When should my child see their healthcare provider?
Always contact your child's healthcare provider if they have any symptoms that worry you. This includes signs and symptoms like eye pain, double vision, blurred vision, and headaches [1].
What questions should I ask my child's healthcare provider?
Question | Why it matters |
What type of exotropia does my child have? | Determines the treatment approach |
What treatment options do you recommend? | Aligns care with severity |
Does my child need surgery? | Planning and expectations |
What are the benefits and risks of surgery? | Informed decision-making |
A note about self-esteem
If your child has exotropia, the condition can affect their self-esteem and may make relationships difficult to form or maintain. When someone doesn't make eye contact, it may appear that they're not paying attention or distracted. That's why it's important to talk to an eye care specialist as soon as you notice the issue. In children, it's important to have an eye exam to make sure each eye is healthy and seeing well. While you can't prevent it from happening, you can act quickly to seek treatment [1].
Key Takeaways
Exotropia — an eye (or both eyes) turning outward — is a form of strabismus that is common in babies and children but can also affect adults. Untreated, it can progress from intermittent to constant, weaken one eye's vision (amblyopia), and cost you binocular vision and depth perception. The good news: it's treatable. Patching, eye drops, corrective lenses, visual therapy, Botox, and surgery all have roles depending on severity, and nonsurgical measures can often control the condition.
If you notice your child's eye turning out, seek treatment right away. Early diagnosis means earlier treatment to correct the alignment — protecting vision, depth perception, and self-esteem. While you can't prevent exotropia, you can act quickly.
Take the Next Step
If your child's eye turns outward — even only sometimes, when they're tired or stressed — book an eye exam with an ophthalmologist or optometrist.
Further reading: AAO — Intermittent Exotropia · AAPOS — Exotropia · Optometrists Network — What is Exotropia?
Frequently Asked Questions
1. What is exotropia?
Exotropia is a form of strabismus — a misalignment of the eyes — in which one or both eyes turn outward, toward the ears. When one eye turns out it's monocular exotropia; when both do, it's bilateral exotropia.
2. What's the difference between exotropia and esotropia?
Exotropia (pronounced "ek-suh-TROH-pee-uh") is the outward turning of one or both eyes, while esotropia is the inward turning of the eyes (crossed eyes). Exotropia is the opposite of esotropia.
3. What are the types of exotropia?
The main types are intermittent exotropia (most common; comes and goes), constant exotropia (always turned out), infantile or congenital exotropia (present at birth), sensory exotropia (in an eye with poor vision), alternating exotropia (switches between eyes), and consecutive (secondary) exotropia (after esotropia surgery).
4. What are the signs of exotropia?
Signs include eyes turned outward some or all of the time, squinting, eye strain, headaches, double vision (diplopia), closing one eye in bright sunlight, and decreased depth perception. It isn't always obvious to the person who has it.
5. What causes exotropia?
Possible causes include genetics (strabismus runs in some families), eye muscle weakness, convergence insufficiency, nervous system conditions like stroke or tumors, and extremely poor vision in one eye. Intermittent exotropia sometimes has no known cause.
6. Can exotropia cause blindness?
Untreated exotropia can lead to amblyopia (poor vision in one eye). Without treatment, you may lose binocular vision (both eyes working together) and have difficulty with depth perception.
7. Does exotropia get worse with age?
It can — exotropia may get worse over time if it's not treated, although many children with intermittent exotropia stay stable or improve. You can manage it, but it may never go completely away, and most types don't resolve completely even with treatment.
8. How is exotropia treated?
Treatment depends on severity and can include eye patching, eye drops (a medical form of patching), corrective lenses, visual therapy (eye exercises), botulinum toxin (Botox) injections into eye muscles, and surgery to tighten or loosen the eye muscles. Sometimes intermittent exotropia stays mild or goes away on its own.
9. Can exotropia be prevented?
No. You can't prevent exotropia, but if you're pregnant or planning pregnancy, you can speak with a genetic counselor about your risk of passing on the condition.
10. What's the outlook for a child with exotropia?
Exotropia may become less frequent over time, but most types don't resolve completely. Nonsurgical treatment may help control the condition, though many people still experience recurrences. Early treatment protects vision, depth perception, and self-esteem.
Related Reading
References
Cleveland Clinic. Exotropia. Cleveland Clinic. Last updated Oct. 30, 2024. https://my.clevelandclinic.org/health/diseases/23440-exotropia
Ma MM, Scheiman M. Divergence excess and basic exotropia types of intermittent exotropia: a major review. Part 2: non-surgical and surgical treatment options. Strabismus. 2024;32(3):159-194. doi:10.1080/09273972.2023.2291056. PMID: 38944823.
Almadani A, Almutairi MN, Kirat EA. Surgical and non-surgical interventions for intermittent exotropia: a systematic review of randomized controlled trials. Cureus. 2026;18(7):e112659. doi:10.7759/cureus.112659. PMID: 42598671.
Medical Disclaimer
This article is for informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read here.
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