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Grading the severity of intermittent distance exotropia: the revised Newcastle Control Score
  1. D Buck1,
  2. M P Clarke2,3,
  3. H Haggerty2,
  4. S Hrisos1,
  5. C Powell2,
  6. J Sloper4,
  7. N P Strong2
  1. 1
    Institute of Health and Society, Newcastle University, UK
  2. 2
    Children’s Eye Clinic and Orthoptic Department, Royal Victoria Infirmary, Newcastle upon Tyne NHS Foundation Trust, UK
  3. 3
    School of Neurobiology, Neurology and Psychiatry, Newcastle University, UK
  4. 4
    Moorfields Eye Hospital, London, UK
  1. M P Clarke, Claremont Wing Eye Department, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK; m.p.clarke{at}

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The Newcastle Control Score (NCS) has been shown to be a reliable, clinically sensitive method for grading the severity of childhood intermittent exotropia (X(T)).1 It incorporates subjective (home control) and objective (clinic control at near and in the distance) criteria, and uses modified descriptions of control as outlined by Rosenbaum and Santiago.2 The home control section asks the parent/guardian to rate the frequency with which the strabismus is noticed to be present, while the clinic components rate the ease with which binocular single vision is regained after a cover test.

The initial development of the NCS resulted in an eight-point scale ranging from 0–7, with higher scores indicating increasing severity. The scoring of the home control item ranges from 0 to 3. The clinic control score, which is assessed for both near and distance, ranges between 0 and 2. A clinic score of 2 for near and/or distance indicates that the strabismus is “manifest spontaneously or with any form of fusion disruption without recovery”. The use of the original version of the NCS has recently been evaluated in a cohort of children with X(T)3 and was confirmed to be a useful measure of the clinical severity of this condition.

The authors are, however, currently administering a revised version of the NCS in a UK study (Improving Outcomes in Intermittent Exotropia (IOXT) study). While there are no new components to the scale, the most severe categories within the clinic control components (referred to above) have been divided into two categories – “remains manifest after dissociation/prolonged fixation” and “manifest spontaneously”. Hence, the total NCS now ranges from 0 to 9. It is envisaged that this modification will increase the sensitivity of the NCS in grading the severity of childhood X(T). A copy of the revised NCS is provided in table 1.

Table 1 The revised NCS


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  • Competing interests: None declared.

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