Exophoria is a type of heterophoria characterized by a tendency for outward deviation of the eyes from the standard visual axis. In the majority of cases, it arises due to convergence insufficiency or inability to maintain proper eye alignment at near vision and the cause is unknown.
Apart from visual observation of the tendency of the eyes to drift outward, symptoms are frequently absent , but when it is a constitutive feature of convergence insufficiency (CI), defined as inability to preserve normal eye alignment at near, it can present with symptoms such as eye fatigue, headaches, and double vision when attempting to perform activities that require near sight, for e.g. reading  . CI, apart from exophoria, can be accompanied by a remote near point of convergence or decreased positive fusional vergence  . Other symptoms that are reported in patients suffering from exophoria are the frequent loss of place when reading, print moving on the page, difficulty concentrating and a short attention span . In some cases, hyperphoria - a permanent upward deviation of the visual axis of the eye, was described as well . Some authors consider that severe exophoria progressively leads to intermittent exophoria, a type of strabismus and that it may develop as early as infancy .
Entire Body System
[…] the tendency of the eyes to drift outward, symptoms are frequently absent, but when it is a constitutive feature of convergence insufficiency (CI), defined as inability to preserve normal eye alignment at near, it can present with symptoms such as eye fatigue [symptoma.com]
We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: May 28, 2019 [patientslikeme.com]
When the eye muscles fatigue, exophoria can become, intermittently, an exotropia. [medhelp.org]
- Movement Disorder
Eye Movement Disorders When you look at an object, you're using several muscles to move both eyes to focus on it. If you have a problem with the muscles, the eyes don't work properly. There are many kinds of eye movement disorders. [icdlist.com]
Coverage includes the most common non-strabismic binocular vision disorders, including accommodative and eye movement disorders as well as amblyopia. [books.google.ro]
Diplopia and eye movement disorders. J Neurol Neurosurg Psychiatry. 2004 Dec. 75 Suppl 4:iv24-31. [Medline]. Ohtsuka K, Maeda S, Oguri N. Accommodation and convergence palsy caused by lesions in the bilateral rostral superior colliculus. [emedicine.medscape.com]
- Surgical Procedure
The most common surgical procedure performed to treat intermittent exodeviation are either bilateral lateral rectus recession or unilateral lateral rectus recession and medial rectus resection.  Additional Resources AAPOS website - frequently asked [eyewiki.aao.org]
Types of exotropia There are different forms of exotropia, let's know below what they are: congenital exotropia Congenital exophoria or divergent strabismus congenital is the one affects from birth causing childhood strabismus. [areaoftalmologica.com]
H50.61 Brown's sheath syndrome H50.69 Other mechanical strabismus H50.8 Other specified strabismus Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes. [icd10data.com]
Exophoria Synonym for Exophoria H00-H59 Diseases of the eye and adnexa (H00-H59)|H49-H52 Disorders of ocular muscles, binocular movement, accommodation and refraction (H49-H52)|H50 Other strabismus|H50.5 Heterophoria Results for Exophoria and additional [averbis.com]
J Am Assoc Pediatr Ophthalmol Strabismus 1997; 1:134-137. [books.google.ro]
[…] exotropes, even when they do not experience diplopia. [bjo.bmj.com]
Sensory testing revealed uncrossed diplopia beyond 6 feet and normal correspondence. [reviewofoptometry.com]
Active anti-suppression and diplopia awareness techniques may be used in cases of suppression. [aimu.us]
Convergence Insufficiency (CI) is the leading cause of eyestrain, blurred vision, double vision (diplopia), and/or headaches. 1 HIGHLIGHTS: Convergence insufficiency is a common near vision problem that -- due to recent scientific research -- is gaining [convergenceinsufficiency.org]
Pagina 16 - Pediatric Eye Disease Investigator Group: The clinical spectrum of early-onset esotropia: experience of the Congenital Esotropia Observational Study. Am J Ophthalmol 133:102-108, 2001 3. [books.google.ro]
Divergent, non-paralytic squint is less common than esotropia, particularly in infancy and childhood, and increases with age. Amblyopia is rare. [gpnotebook.co.uk]
Consecutive Exotropia Exotropia following surgical overcorrection of esotropia called consecutive exotropia. Treatment 1.Wait atleast for six month if deviation is not much. 2. [squintmaster.com]
Otherwise, bimedial recession is usually the procedure of choice for a consecutive esotropia, especially if the esotropia is greater at near. [eyerounds.org]
Symptoms of basic esophoria include: eyestrain, headaches, blurred or double vision, apparent movement of print, and difficulty concentrating on and comprehending reading material. [naturaleyecare.com]
Symptoms of Convergence Insufficiency (Headaches, Eyestrain, Anxiety, etc.) [convergenceinsufficiency.org]
Symptoms of basic esophoria include: eyestrain, headaches, blurred or double vision, apparent movement of print difficulty concentrating on and comprehending reading material. [2020detroit.com]
[…] tendency of the eyes to drift outward, symptoms are frequently absent, but when it is a constitutive feature of convergence insufficiency (CI), defined as inability to preserve normal eye alignment at near, it can present with symptoms such as eye fatigue, headaches [symptoma.com]
There is no cure for some kinds of eye movement disorders, such as most kinds of nystagmus. [icdlist.com]
[…] classified ( R00 - R94 ) syphilis related eye disorders ( A50.01, A50.3-, A51.43, A52.71 ) Diseases of the eye and adnexa H49-H52 2019 ICD-10-CM Range H49-H52 Disorders of ocular muscles, binocular movement, accommodation and refraction Type 2 Excludes nystagmus [icd10data.com]
Hemianopsia binasal bitemporal homonymous Quadrantanopia subjective Asthenopia Hemeralopia Photophobia Scintillating scotoma Pupil Anisocoria Argyll Robertson pupil Marcus Gunn pupil Adie syndrome Miosis Mydriasis Cycloplegia Parinaud's syndrome Other Nystagmus [worldlibrary.org]
Eyes Vision Symptoms, Testing & Treatment for ADHD, Vertigo, Anxiety, Migraines, etc. [convergenceinsufficiency.org]
[…] spilling or knocking over of objects Bumping into doors, furniture and other stationary objects Sports accidents Avoidance of eye contact Poor posture while doing activities requiring near vision Frequent head tilt Problems with motion sickness and/or vertigo [optometrists.org]
Often movement in a crowded environment becomes quite disturbing and may cause symptoms of vertigo. This can be extremely debilitating to the patient. [braininjuries.org]
[…] result of CI— these are the most common: Eyestrain Headaches or muscle tension Blurred or double vision Difficulty reading and concentrating Uses finger or ruler when reading Avoidance of close work Poor hand-eye coordination Anxiety Motion sickness/dizziness [optometrists.org]
Physicians can make a preliminary diagnosis just by close inspection of the eyes during the physical examination, while patient history can reveal signs and symptoms that indicate problems with near vision. Some tests, however, may be employed to confirm exophoria as the cause of symptoms. Firstly, simple cover testing and evaluation of accommodation can be performed, which will provoke the outward movement of the eye in virtually all cases. The Snellen chart should not be used as a sole diagnostic method, since it may reveal completely normal findings in patients suffering from exophoria. The severity of prism diopter (PD) deviation should be examined by skilled ophthalmologists, in order to evaluate the need for correction .
Treatment of Convergence Insufficiency Treatments for CI can be categorized as active or passive: Active treatment : A multi-site randomized clinical trial funded by the National Eye Insitute has proven that the best treatment for convergence insufficiency [convergenceinsufficiency.org]
Treatment options. Vision therapy is an effective treatment option. [naturaleyecare.com]
In the case of reoccurrence, treatments will again correct the condition. [healthline.com]
Tenacious proximal fusion is an indicator of a good surgical prognosis. [eyewiki.aao.org]
The conclusions drawn from his data are: A high AC/A is an indicator of a poor surgical prognosis and most of these patients have a consecutive esotropia at near. Tenacious proximal fusion is an indicator of a good surgical prognosis. [eyerounds.org]
The article on "Muscle Imbalance in Myopia" by Marlow 1 in the April issue of the Archives of Ophthalmology stressed an element in the etiology of progressive myopia which has been too long overlooked. [jamanetwork.com]
Keywords: accommodation • vergence • strabismus: etiology © 2011, The Association for Research in Vision and Ophthalmology, Inc., all rights reserved. [iovs.arvojournals.org]
[…] myopia as the sole cause of exophoria Baum  also reported that myopia cannot be held responsible for exophoria Pascal  was of the view that exophoria is almost always secondary to myopia Recently Burian  stated that the role of myopia in the etiology [ijo.in]
Etiology The etiology of exotropia is unknown, but on a rudimentary level there is impaired ability to maintain fusion and alignment. In the case of sensory exotropia, the poor acuity of one eye is the cause of the inability to maintain alignment. [eyewiki.aao.org]
All the statistical and epidemiologic analysis was performed using the statistical software SPSS 15.0 for Windows and the EPIDAT 3.1 program. 3. [hindawi.com]
Secondary Form The epidemiology of primary and secondary form appears similar, with highest incidence among adults, but pediatric cases are reported sporadically as well. [reviewofophthalmology.com]
hyper- Upwards-deviating hypo- Downwards-deviating cyclo- Tilted or torsed about an eye’s visual axis comitant Ocular deviation present in all directions of gaze incomitant Ocular deviation only present in specific directions of gaze Aetiology and epidemiology [geekymedics.com]
EPIDEMIOLOGY Variable incidence Affects 2.25-8.3% of population Bimodal peak incidence at High school or college age, when there is an increased demand for near work Early middle age, secondary to initiation of bifocal use and decreased accommodative [webeye.ophth.uiowa.edu]
Pathophysiology of exodeviation. In: symposium on horizontal ocular deviation. St. Louis, Ed. Manley DR. 1971 Mosby-Year Book, Inc., pg 119 ↑ 9.0 9.1 Costenbader FD. The physiology and management of divergent strabismus. [eyewiki.aao.org]
Pathophysiology of exodeviation. In: symposium on horizontal ocular deviation. St. Louis, Ed. Manley DR. 1971 Mosby-Year Book, Inc., pg 119 Costenbader FD. The physiology and management of divergent strabismus. [eyerounds.org]
CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. [pointsdevue.com]
Latent vs Manifest The correct alignment of the eyes is guaranteed by normally functioning sensory and motor fusion mechanisms If sensory fusion is artificially prevented, by occlusion, distortion etc. motor fusion will be prevented and a measurable degree [slideshare.net]
Neuro-ophthalmological examination at an earlier stage could have prevented unnecessary neuroimaging and botulin injections. [bjo.bmj.com]
The symptoms I have obviously bother me, and I would consider this option to rid myself of them if therapy/prevention did not work. [medhelp.org]
- Jung JW, Lee SY. A Comparison of the Clinical Characteristics of Intermittent Exotropia in Children and Adults. Korean J Ophthalmol. 2010;24(2):96–100.
- Saunte JP, Holmes JM. Sustained improvement of reading symptoms following botulinum toxin A injection for convergence insufficiency. Strabismus. 2014;22(3):95-99.
- Bade A, Boas M, Gallaway M, et al. Relationship between Clinical Signs and Symptoms of Convergence Insufficiency. Optom Vis Sci. 2013;90(9):988-995.
- Scheiman M, Gwiazda J, Li T. Non-surgical interventions for convergence insufficiency. Cochrane Database Syst Rev. 2011;(3):CD006768.
- Gupta NC, Narang RK, Khurana AK, Parmar IP, Ahluwalia BK. Exophoria and refractive errors-evaluation of 250 cases. Indian J Ophthalmol. 1987;35(4):204-206.