Comparison of the Surgical Treatment for Strabismus According to Its Type: Esotropia Versus Exotropia

Background: The direction of deviation in strabismus may influence the predictability of the surgical procedure, but this factor remains insufficiently investigated. The aim of this study was to compare postoperative changes in ocular deviation, measured by video oculography, following surgical treatment in patients with concomitant exotropia and esotropia. Methods: A prospective longitudinal study included 49 patients with horizontal strabismus. All patients underwent an eye examination before and after surgery, with ocular deviation measured in nine gaze positions using video oculography. Preoperative and postoperative results were analyzed separately for esotropias and exotropias to assess surgical efficacy in both conditions. Results: Ocular deviation significantly improved after strabismus surgery in both esotropia and exotropia across all nine gaze positions (p < 0.05). The greatest improvement was observed in the primary position, with an efficacy rate of 75% in exotropia (mean reduction of 14.93 prism diopters) and 78% in esotropia (mean reduction of 17.50 prism diopters). Residual postoperative deviation was similar between the two types of strabismus (p > 0.05). In non-primary gaze positions, surgical efficacy was lower—particularly during complex eye movements—in both groups. Conclusions: Strabismus surgery resulted in a significant reduction in ocular deviation across all gaze positions in patients with concomitant horizontal strabismus, as objectively assessed by video oculography. Postoperative improvements were comparable between exotropia and esotropia, with the highest surgical efficacy observed in the primary gaze position. These findings support the use of objective multigaze evaluation to more comprehensively characterize postoperative alignment and to inform future assessments of surgical outcomes.