SynthesisPeerJ2026
Effectiveness of treatment approaches for childhood exotropia: a systematic review.
Synthesis in PeerJ, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Authors and funding
2 authors.
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No grant is acknowledged in the PubMed record.
Abstract
Background: Exotropia (XT), an outward ocular deviation, commonly affects children. Delayed treatment increases the risk of amblyopia and visual impairment. The aim of this systematic review is to evaluate the evidence on the effectiveness, indications, and clinical outcomes of different treatment modalities for childhood XT. Methods: A systematic search was performed in PubMed, Web of Science, ProQuest, Scopus, Google Scholar, EBSCO, and Medline in accordance with PRISMA 2020 guidelines. Articles published between 1997 and 2025 on treatment approaches for childhood XT were included. Treatment success was defined as a post-intervention deviation of ≤10 prism diopters (PD). The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD420251174532. Results: The final review included 34 studies from 11 countries, comprising 3,643 children with a mean age of 5.70 ± 2.24 years. The reviewed studies indicated that part-time occlusion and office-based vergence and anti-suppression therapy (OBVAT) achieved the highest short-term effectiveness rate of 86.8% after follow-up of five months. Overminus lenses therapy achieved a success rate of 80.63% with a follow-up of 2.15 years. Extraocular muscle surgery achieved a success rate of 70.81% with follow-up of 3.68 years, whereas botulinum toxin type A (BTX-A) injection showed a lower effectiveness rate of 66.86% after follow-up of 1.67 years. Conclusion: Multiple surgical and non-surgical options exist for managing childhood XT. Overminus lenses can improve distance control during testing, but deviation typically return to original state with non-overminus lenses, and their use requires monitoring for possible myopic progression. Surgery remains the primary treatment for constant XT, with bilateral lateral rectus recession and unilateral lateral rectus recession and medial rectus resection (R&R) showing similar short-term outcomes and long-term advantages for R&R. BTX-A offers a minimally invasive alternative for selected cases. Part-time occlusion and OBVAT improve short-term control, however durability and optimal protocols remain uncertain.
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