Strabismus Surgeries for Triad Exotropia in Younger Children

The triad of “A” pattern horizontal strabismus, superior oblique overaction (SOOA), and dissociated vertical deviation (DVD) is referred to as Helveston syndrome or triad exotropia, and is an uncommon, bizarre combination of ocular motility disturbance, which is usually treated with combination of surgery consisting of bilateral SO weakening, superior rectus recession, and lateral rectus recession. The authors report cases of triad exotropia in children younger than 3 years of age who showed excellent surgical results without SO weakening. As condition has not often been reported, the authors hope that this case review provides a better understanding of the obscure etiology of this symptom complex.