Abstract: Objective To evaluate the effect of press-on prism test for eye position observation and adjustable suture of recus muscle of early surgical intervention in congenital exotropia. Design Retrospective case series.  Participants We reviewed 25 subjects diagnosed with congenital exotropia in Beijing Children Hospital in 2008-2012, aged 10 months to 67 months (28.84±16.01 months). Of the 25 cases, 1 case of intermittent exotropia, 24 cases of constant exotropia. 4 cases existed with V sign, 4 cases with DVD, 1 case with V sign and DVD, 1 case with nystagmus. Methods Pressure prism test for deviation degree was used in young children before or after surgery.  Adjustable suture of recus muscle was used during surgery. The follow-up was performed on 1 day, 2 weeks, 1 months, 6 months, and 12 months after surgery. Main Outcome Measures The angle of near and far deviation in primary position. Result Pressure prism test has good compliance in young children. On 1 day after operation, 80% patients had a deviation of less than 10 PD, and 2 weeks after adjusting suture 100% patients had a deviation of  ＜10 PD (P＜0.05). On half a year eye position change of strabismus degree was not obvious. One year after the operation (-7.12±3.24△) had a tendency to develop in the direction of exotropia with time and surgical success rate was 88%. Conclusion Press-on prism test can be used in congenital exotropia in young children for preoperative strabismus degree examination. Application of adjustable suture obviously increases the success rate of congenital exotropia.  (Ophthalmol CHN, 2014, 23: 57-60)

Key words: congenital exotropia/surgery, press-on prism test, adjustable suture