Thank you for showing interest in our study. Our explanations are as follows:

Your point regarding the Bieschowsky test is all right. There are several possible explanations for our results. First of all, we do not believe that our patients did have true paralytic strabismus. The positive Bielschowsky test that is a telltale sign of SO palsy (SOP) would not be applicable to our cases strictly. All SOPs were excluded as we have already mentioned this in the article. So we termed them as ipsilateral (hypertropic) side and contralateral (hypotropic) side rather than paralytic or nonparalytic side. Therefore we may not obtain the same findings as true SOP. Second, the bilateral cases were included in 30% of our cases as shown in Table 3. The amount of hyperdeviation in the primary position is very small in bilateral cases because one eye had to be used for fixation. It may have caused the mean deviation in primary gaze to be smaller. We gathered the results of Bielschowsky head tilt test in individual cases and averaged those. The individual values may be more understandable, as many of them showed more hypertropia on the hypertropic side.

In our study, all the patients did not have amblyopia. A limitation of the study was not having included the results of the sensory test even if they had been performed. Whenever we see strabismic patients, we check the sensory status with Titmus fly test, Randot stereo test, and Lang test. We absolutely agree with your opinion that the sensory state can affect the surgical outcome of these cases. However, we did not want the sensory results to obscure our message. Basically, we would like to focus on why hyperdeviation occurs in intermittent exotropia and disappears postoperatively. We think our results for 1-year follow-up are adequate to explain this interesting phenomenon. Hyperdeviation was not observed in the status of good fusion without recurrence. The surgical outcome according to the follow-up period is another concern. Actually, we reported ‘Surgical outcome in 585 patients with intermittent exotropia’ at the AAPOS annual meeting in USA 2 years ago. They were followed up for more than 5 years.