To evaluate the clinical characteristics of exodeviated patients with accomodative esotropia and orthophoric hyperopia.

We conducted a retrospective chart review of patients with accommodative esotropia and hyperopia who later developed exotropia and visited the Department of Ophthalmology of Wonju Severance Christian Hospital from January 1, 1997 to December 31, 2013.

The study included 13 patients with a mean age of 4.1 years at initial referral. At the initial visit, nine patients (69.2%) had accommodative esotropia with a median of 25.5 PD esotropia at near gaze. Among the esotropic patients, four patients (44.4%) had unilateral amblyopia and five patients (55.6%) had bilateral amblyopia. The spherical equivalent was +6.09 D in the amblyopic eye and +5.63 D in the dominant eye. In the cases of bilateral amblyopia, the spherical equivalent was +5.875 D. Spontaneous consecutive exotropia developed at a mean age of 8.63 years (average follow-up of 56.38 months). Mean exodeviation was 10.33 PD. Among the four patients (30.8%) who were orthophoric at their initial visit, two patients (50%) had unilateral amblyopia and two (50%) had bilateral amblyopia. The spherical equivalents of the amblyopic eye and the dominant eye were +5.63 D and +3.13 D, respectively. In cases of bilateral amblyopia, a mean spherical equivalent of +5.50 D was observed. The mean age when exodeviation occurred was 10.75 years, which was 64 months after the initial visit. The average exodeviation was 6.5 PD.

When treating accommodative esotropia and hyperopia, long-term observation is necessary since exodeviation could develop. Exotropia was successfully managed with spectacle correction. Further studies are needed for possible surgical intervention.