<b>EVALUATION OF BINOCULAR SINGLE VISION IN CHILDREN WITH INTERMITTENT EXOTROPIA</b>

Background: Intermittent exotropia (IXT) is a common pediatric strabismus characterized by intermittent outward deviation, affecting binocular single vision (BSV), sensory fusion, and stereopsis. Assessing BSV in IXT is crucial to understand sensory adaptations, control of deviation, and visual prognosis. Objective: To evaluate the presence of binocular single vision in children diagnosed with intermittent exotropia. Methods: A descriptive cross-sectional study was conducted over four months at the University of Lahore Teaching Hospital. Seventy children aged 3–16 years with IXT ≥10 prism diopters (PD) at near or distance were examined using non-probability convenience sampling. Assessment included visual acuity, alternate prism cover test (PCT) at near and distance, Worth 4 Dot (near & distance), and Frisby stereopsis. Data were analyzed using SPSS-27. Kruskal–Wallis test was used due to non-normal data distribution. A p-value <0.05 was considered significant. Results: At near, Worth 4 Dot responses showed: Normal Retinal Correspondence (NRC) 9 (12.9%), Alternate Suppression 36 (51.4%), and Abnormal Retinal Correspondence (ARC) 25 (35.7%). NRC correlated with good stereopsis (85 arcsec), whereas Alternate Suppression was linked with poor stereopsis (340 arcsec in 33 children). At distance, Alternate Suppression predominated (62 children). Larger deviations (25–30 PD) were associated with suppression, whereas ARC was more common in smaller deviations (14–16 PD). Kruskal–Wallis showed significant differences across PCT groups for Worth 4 Dot Near (H=13.6, p=0.034) and Distance (H=69.0, p=0.000), but not for Frisby stereopsis (H=7.372, p=0.288). Conclusion: Larger deviations in IXT are strongly associated with suppression and poor stereopsis, whereas smaller deviations show a tendency toward ARC with preserved or variable stereopsis. BSV in IXT demonstrates a dynamic interaction between sensory adaptation and ocular misalignment.