The opposite of being cross-eyed is called being “wall-eyed,” and the medical term is exotropia. While cross-eyed (esotropia) means one or both eyes turn inward toward the nose, exotropia means one or both eyes turn outward toward the ears. Both conditions fall under the umbrella of strabismus, which is the general term for any misalignment of the eyes.
Cross-Eyed vs. Wall-Eyed
The distinction is purely directional. In esotropia (cross-eyed), the eyes deviate inward, making it look like both eyes are focused on the nose. In exotropia (wall-eyed), one or both eyes drift outward, as if looking toward the side of the head. Both conditions can affect one eye or alternate between the two.
Interestingly, which type is more common depends on where you live. In European populations, about 63% of people with eye misalignment have the inward-turning type. In East Asian populations, the pattern reverses: roughly 74% have the outward-turning type. Researchers don’t fully understand why this geographic difference exists, but it’s one of the more striking patterns in eye health.
Types of Exotropia
Not all outward eye drifting looks the same or behaves the same way.
- Intermittent exotropia is the most common form. It typically appears between infancy and age 7, and the eye only drifts outward some of the time, particularly when a person is tired, sick, or mentally unfocused. Many people with intermittent exotropia are otherwise asymptomatic, though children with the condition sometimes close one eye in bright light.
- Congenital exotropia appears in the first six months of life. It’s usually a large, constant outward deviation that doesn’t resolve on its own.
- Sensory exotropia develops when one eye has very poor vision. In young children under about age 2, a poorly seeing eye tends to turn inward (cross-eyed). But in older children and adults, the same situation typically causes the eye to drift outward instead. The poor vision prevents the brain from keeping both eyes locked on the same target.
Why Eyes Drift Outward
Your eye position is controlled by six small muscles attached to each eyeball, coordinated by cranial nerves that run from your brain. When these muscles pull unevenly, or when the nerve signals controlling them are disrupted, the eyes fall out of alignment. For outward drifting specifically, the muscle that pulls the eye toward the ear (the lateral rectus) can overpower the one pulling it toward the nose, or the opposing muscle may be weakened.
Nerve damage is one cause. The sixth cranial nerve controls the muscle that pulls your eye outward. When this nerve is damaged by head injuries, infections like shingles or meningitis, or other neurological conditions, it disrupts the balance of forces acting on the eye. In other cases, exotropia develops without any identifiable nerve problem, possibly due to differences in how the brain coordinates the two eyes.
How It Affects Vision
When both eyes point in different directions, the brain receives two conflicting images. In adults, this often causes double vision. In children, the brain frequently adapts by suppressing the image from the drifting eye, effectively ignoring it. This solves the double vision problem but comes at a cost: depth perception suffers because judging distance relies on both eyes working together.
With intermittent exotropia, people often have normal depth perception when both eyes are aligned and only lose it during episodes when the eye drifts. This is why the condition can go unnoticed for long stretches, especially in children who may not realize their vision is different from anyone else’s.
Treatment Options
Treatment depends on how frequent and severe the outward drift is. For intermittent exotropia, some eye care providers start with observation, especially in young children, since the drift may remain well-controlled for years. Vision therapy exercises can help strengthen the brain’s ability to keep both eyes aligned, and special glasses with prism lenses can reduce the effort needed to keep the eyes straight.
Surgery is the primary option for constant or worsening exotropia. The procedure adjusts the tension on the eye muscles to bring the eyes into better alignment. For large-angle deviations, success rates hover around 69% to 75% at two-year follow-up, with success defined as the eyes staying within a small range of proper alignment. Surgeons sometimes aim for a slight initial overcorrection because the eyes tend to drift back outward somewhat during healing.
For sensory exotropia caused by poor vision in one eye, treating the underlying vision loss (when possible) is a key part of the plan, since the alignment problem stems from the brain’s inability to fuse images from both eyes.