Sagging eye syndrome (SES) is a cause of acquired strabismus in an older adult.
Mechanism: age-related involution of orbital connective tissue
Patient selection: adult > 40 years old
Clinical features:
(1) acquired binocular diplopia with vertical and horizontal strabismus
(2) blepharoptosis (drooping of the upper eyelid)
(3) superior sulcus defect
(4) significant displacement of the lateral rectus (LR) pulley
(5) elongation of the rectus extraocular muscles
(6) thinning and/or rupture of the lateral rectus-superior rectus band
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Sagging of the Lateral Rectus
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Results in
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symmetrical
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divergence paralysis esotropia (divergence insufficiency)
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asymmetrical
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cyclovertical strabismus
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Differential diagnosis includes:
(1) heavy eye syndrome
(2) highly myopic strabismus
