To be or not to be: Surgery for exotropia with homonymous hemianopia

Background/PurposeIn patients with early-onset homonymous hemianopia, ipsilateral exotropia and face turn could be a functional adaptation/compensation to expand the visual field. This case series study analyzed early-onset exotropia with homonymous hemianopia.MethodsMedical records of eight consecutive patients with early-onset exotropia and homonymous hemianopia were reviewed.ResultsThe five females and three males in this study (age range, 6–48 years) were followed up for an average of 28.3 months. In all patients, the fixating eye was contralateral to the side of the (major) visual field defect except in one patient (case 6) with maculopathy in the contralateral eye. Of the four patients who received strabismus surgery, one had troublesome diplopia after the surgery while the other three were free of complications.ConclusionsSome patients with homonymous hemianopia and exotropia, particularly young and/or female patients, may conclude that the cosmetic and psychosocial gains achieved by strabismus surgery outweigh the potential surgical complications such as decreased visual field or diplopia. However, these patients require consultation and thorough education in the potential outcomes of the procedure.