Abstract:  Objective To study the clinical characteristics and quality of life of adult patients with sensory exotropia in China, and to analyze the factors affecting the quality of life of patients. Design Prospective case-control study. Participants Twenty-seven adult patients with sensory exotropia were enrolled in Beijing Tongren Hospital from January 2023 to September 2023 as the case group, and 54 patients with other types of strabismus were collected as the strabismus control group, and 54 orthotropic people were enrolled as the normal control group. Methods The causes of disused eyes in patients with sensory exotropia were analyzed. Patients aged 18-40 years were treated with compound topiramate mydriasis refraction, patients aged over 40 years were treated with apparent refraction, best corrected visual acuity (BCVA) was tested by standard logarithmic visual acuity chart. The near stereopsis was tested by Yan-style stereogram, the far stereopsis was tested by synoptophore, and the horizontal and vertical deviations were measured by prism+alternate covering or prism+corneal reflection (low vision, unable to gaze). The quality of life of patients was evaluated by the Chinese version of the Adult Strabismus Patients Quality of Life Scale (CAS-20). The differences in general characteristics, visual function and quality of life among normal control group, sensory exotropia group and other type’s strabismus group were analyzed. The effects of individual factors and visual function on the quality of life of patients with sensory exotropia were analyzed. Main Outcome Measures BCVA, refraction, deviation, far and near stereopsis, course of disease, the quality of life scores of social psychology and visual function. Results The BCVA of 27 patients with disused exotropia was lower than 0.1. The average deviation was (84.60±12.73)△. The average deviation of other strabismus group was (57.45±17.65)△, the difference was statistically significant (Z=5.063, P=0.014). The main causes of sensory exotropia were acquired (ocular trauma was the most common). The proportion of patients with family history (0%) was lower than that of other types of strabismus group (16.67%) (P=0.024). All patients with sensory exotropia had no stereopsis, which was significantly lower than that of normal group and other strabismus groups (P<0.001). The course of sensory exotropia was longer than that of other strabismus groups (Z=9.556, P=0.002). There were statistically significant differences in the social psychological scores and visual function scores among the three groups. The total score of social psychological score insensory exotropia group was significantly lower than that of normal group (Z=-7.368, P<0.001) and other strabismus groups (Z=-3.139, P=0.020). The total score of visual function in sensory exotropia group was significantly lower than that of normal group (Z=-7.286, P<0.001), but there was no statistically significant difference between sensory exotropia group and other strabismus groups (Z=-1.540, P=0.124). Among the influencing factors of the quality of life of patients with sensory exotropia, the diopter of the disused eye was negatively correlated with the social psychological score (r=-0.375, P=0.002). The diopter of the disused eye was negatively correlated with the visual function score (r=-0.366, P=0.003). The BCVA of the disused eye was positively correlated with the social psychological score (r=0.326, P=0.005). The BCVA of the disused eye was positively correlated with the visual function score (r=0.313, P=0.006). The longer the course of strabismus was, the lower the social psychological score was (Z=7.037, P=0.021). Conclusion Compared with the normal population and other strabismus patients, the visual function of the affected eye in Chinese adult patients with sensory exotropia is seriously damaged, completely without binocular visual function, and the health-related quality of life is significantly reduced. The higher diopter of the disused eye, the poorer corrected visual acuity, and the longer course of strabismus are the main factors affecting the quality of life of patients. (Ophthalmol CHN, 2024, 33: 127-131)

Key words: sensory exotropia, quality of life