. 2020 Jan:209:55-61.

doi: 10.1016/j.ajo.2019.09.006. Epub 2019 Sep 14.

Prevalence of Sagging Eye Syndrome in Adults with Binocular Diplopia

Toshiaki Goseki¹, Soh Youn Suh², Laura Robbins², Stacy L Pineles², Federico G Velez³, Joseph L Demer⁴

Affiliations

¹ Department of Ophthalmology, University of California Los Angeles, Los Angeles, California, USA; UCLA Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA; Department of Ophthalmology, Kitasato University School of Medicine, Sagamihara, Japan.
² Department of Ophthalmology, University of California Los Angeles, Los Angeles, California, USA; UCLA Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA.
³ Department of Ophthalmology, University of California Los Angeles, Los Angeles, California, USA; Department of Ophthalmology, Duke University, Durham, North Carolina, USA.
⁴ Department of Ophthalmology, University of California Los Angeles, Los Angeles, California, USA; UCLA Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA; Department of Neurology, David Geffen Medical School at University of California, Los Angeles, California, USA; Neuroscience Interdepartmental Program, David Geffen Medical School at University of California, Los Angeles, California, USA; Bioengineering Interdepartmental Program, David Geffen Medical School at University of California, Los Angeles, California, USA; David Geffen Medical School at University of California, Los Angeles, California, USA. Electronic address: jld@jsei.ucla.edu.

PMID: 31526795
PMCID: PMC6911643
DOI: 10.1016/j.ajo.2019.09.006

Prevalence of Sagging Eye Syndrome in Adults with Binocular Diplopia

Toshiaki Goseki et al. Am J Ophthalmol. 2020 Jan.

. 2020 Jan:209:55-61.

doi: 10.1016/j.ajo.2019.09.006. Epub 2019 Sep 14.

Authors

Toshiaki Goseki¹, Soh Youn Suh², Laura Robbins², Stacy L Pineles², Federico G Velez³, Joseph L Demer⁴

Affiliations

¹ Department of Ophthalmology, University of California Los Angeles, Los Angeles, California, USA; UCLA Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA; Department of Ophthalmology, Kitasato University School of Medicine, Sagamihara, Japan.
² Department of Ophthalmology, University of California Los Angeles, Los Angeles, California, USA; UCLA Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA.
³ Department of Ophthalmology, University of California Los Angeles, Los Angeles, California, USA; Department of Ophthalmology, Duke University, Durham, North Carolina, USA.
⁴ Department of Ophthalmology, University of California Los Angeles, Los Angeles, California, USA; UCLA Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA; Department of Neurology, David Geffen Medical School at University of California, Los Angeles, California, USA; Neuroscience Interdepartmental Program, David Geffen Medical School at University of California, Los Angeles, California, USA; Bioengineering Interdepartmental Program, David Geffen Medical School at University of California, Los Angeles, California, USA; David Geffen Medical School at University of California, Los Angeles, California, USA. Electronic address: jld@jsei.ucla.edu.

PMID: 31526795
PMCID: PMC6911643
DOI: 10.1016/j.ajo.2019.09.006

Abstract

Purpose: Sagging eye syndrome (SES), horizontal and/or vertical strabismus caused by orbital connective tissue degeneration, was first defined 10 years ago. This study investigated SES and other causes of acquired binocular diplopia in adults presenting to a single institution since the description of SES.

Design: Retrospective observational case series.

Methods: Medical records were reviewed of all new patients over the age of 40 who presented to the Stein Eye Institute with binocular diplopia between January 2015 and December 2018. Clinical causes of diplopia were tabulated in patients grouped by age and sex. In patients with SES, we tabulated binocular alignment, types of treatment, and surgical outcomes.

Results: There were 945 patients of mean age 66.5 years, of whom 514 (54.4%) were female. The most common cause of diplopia was SES (31.4%). The 297 patients with SES were older at 71.2 years (P < 0.0001) and more predominantly female at 59.9% than other patients (52.0%; P = 0.023). The relative proportion of SES patients among all diplopic patients increased with age from 4.7% under age 50 years to 60.9% over the age of 90. Age-related distance esotropia was present in 35% and cyclovertical strabismus in 65% of cases of SES. Strabismus surgery was performed in 50% of cases of SES. Mean esotropia at distance decreased from 6.9 ± 0.7Δ preoperatively to 0.3 ± 0.3Δ postoperatively. Preoperative hypertropia decreased from 3.0 ± 0.3Δ to 0.7 ± 0.2Δ postoperatively. Surgery resolved diplopia in all cases.

Conclusions: It is important to recognize that SES is a very common cause of adult binocular diplopia.

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Conflict of interest statement

Conflict of Interest: No conflicting relationship exists for any author.

Figures

**Fig. 1:**
Ages of patients presenting with acquired binocular diplopia.

**Fig. 2:**
Causes of diplopia. The most common cause of diplopia was sagging eye syndrome.

**Fig. 3.**
A: Age distribution of new patients presenting with acquired binocular diplopia. The average age of patient with sagging eye syndrome was 71 ± 10 (Mean ± SD) years. The average age of patients presenting with other causes of diplopia was 64±12 years (*** P< 0.0001). B. The proportion of diplopia due to sagging eye syndrome increases with age.

**Fig. 4:**
Strabismus angle in two types of sagging eye syndrome. ARDE - age-related distance esotropia. CVS - cyclovertical strabismus with or without esotropia.

**Fig. 5:**
Treatment of sagging eye syndrome.

**Fig. 6:**
Strabismus angles before and after strabismus surgery for sagging eye syndrome. (*** P< 0.0001).

See this image and copyright information in PMC

Comment in

Comment on: Prevalence of Sagging Eye Syndrome in Adults With Binocular Diplopia.
Mohney BG. Mohney BG. Am J Ophthalmol. 2021 Jan;221:323-324. doi: 10.1016/j.ajo.2020.07.055. Epub 2020 Oct 21. Am J Ophthalmol. 2021. PMID: 33097175 No abstract available.
Reply to: Comment on Prevalence of Sagging Eye Syndrome in Adults with Binocular Diplopia.
Goseki T, Suh SY, Robbins L, Pineles SL, Demer JL, Velez FG. Goseki T, et al. Am J Ophthalmol. 2021 Jan;221:324-325. doi: 10.1016/j.ajo.2020.08.010. Epub 2020 Oct 21. Am J Ophthalmol. 2021. PMID: 33097177 No abstract available.

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Prevalence of Sagging Eye Syndrome in Adults with Binocular Diplopia

Affiliations

Prevalence of Sagging Eye Syndrome in Adults with Binocular Diplopia

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical