To investigate surgical results (≥3 years) for exotropia and factors associated with the outcome.

Clinical records of 259 patients who underwent surgery for exotropia and had 3 or more years of follow-up were retrospectively reviewed. Surgical success was defined as esodeviation less than 5 prism diopters (Δ), orthophoria, or exodeviation less than 10Δ on the third year after operation. Overcorrection was defined as esodeviation greater than 5Δ and recurrence as exodeviation greater than 10Δ. Both overcorrection and recurrence were considered as surgical failure. Factors including age at surgery, gender, preoperative refractive errors, preoperative stereopsis, preoperative maximum deviation, type of surgery, and alignment at postoperative week 1 were investigated.

Out of 259 patients, 155 patients (59.8%) achieved surgical success, 19 patients (7.3%) showed overcorrection and 85 patients (32.8%) had recurrence. Out of 44 patients (17.0%) who underwent reoperation, 2 patients showed overcorrection and 42 patients had recurrence. Alignment at postoperative week 1 was the only significant factor affecting the surgical results. The type of surgery was the only significant factor associated with reoperation after failure of the initial surgery.

Alignment at postoperative week 1 was the only significant factor affecting surgical results. The type of surgery was the only significant factor associated with reoperation.