Background and Characteristics of Elderly Patients with Binocular Diplopia
Manami Kawai, CO; Toshiaki Goseki, MD,PhD; Hitoshi Ishikawa, MD,PhD; Miki Hoshina, CO; Nobuyuki Shoji, MD,PhD
Department of Ophthalmology, Kitasato University School of Medicine
1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan
Introduction: In recent years, with the development of orbital diagnostic imaging and pathology research, diseases caused by abnormalities in orbital pulleys (such as sagging eye syndrome and severe myopic strabismus) have been reported more often. In this study, we evaluated the background and characteristics of elderly patients with binocular diplopia as a main complaint.
Methods: The participants were 236 patients aged 60 years or older who visited the hospital for binocular diplopia as a main complaint between April 2014 and March 2017 (male:female = 137:99). The age of the patients was 71.6 ± 7.5 years. We classified strabismus by types and investigated the cause and treatment for each group. We diagnosed orbital pulley disorders using magnetic resonance imaging. Patients with orbital pulley disorders exhibited esotropia and/or vertical strabismus and did not present with cranial nerve palsy, systemic illness, or ocular injury.
Results: The cases of strabismus associated with vertical deviation were 50.9% of the total cases. The causes of disease in each group were as follows: convergence insufficiency exotropia (50.9%) and basic exotropia (21.1%) in the exotropia group; orbital pulley disorder (35.6%) and abducens nerve palsy (33.9%) in the esotropia group; IV paralysis (32.4%) and orbital pulley disorder (31.0%) in the vertical strabismus group; and orbital pulley disorder (28.6%) and IV paralysis (28.6%) in the combined strabismus group.
Discussion: About half of the elderly patients with binocular diplopia exhibited vertical deviation. In addition, binocular diplopia was mainly caused by orbital pulley disorders.
Conclusion: Orbital pulley disorders may be major causes for strabismus in elderly patients.
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