The Management of Vertical Deviations in Sagging Eye Syndrome
Shauna Berry, DO; Stacy L. Pineles, MD; Joseph L. Demer, MD; Federico Velez, MD
Stein Eye Institute
Los Angeles, CA
Introduction: Sagging eye syndrome (SES) may cause acquired distance esotropia secondary to degenerative changes of the lateral rectus-superior rectus band and subsequent inferior displacement of the lateral rectus muscle.1 Asymmetric displacement of the lateral rectus muscles may result in vertical deviations.1 Recent reports indicate changes in vertical rectus muscles in patients with SES.2,3 This study was conducted to report findings and management of SES patients with vertical deviations.
Methods: Charts were reviewed of patients with acquired vertical deviations associated with SES. Only those with a minimal follow-up of 1 year were included. Preoperative and postoperative alignment, ocular rotations, and torsion were evaluated.
Results: A total of 21 patients were included. Mean preoperative vertical deviation measured 2±1 (standard deviation). Mean preoperative torsion measured 5.1±2.2° with a mean postoperative torsion of 0.7±1.7° All patients underwent horizontal muscle surgery. In ten patients who underwent simultaneous inferior rectus recession, the preoperative vertical deviation improved from 2.8±1.3 to 0.2±0.6. In 3 patients who underwent simultaneous superior rectus tightening procedures, the preoperative vertical deviation improved from 2.6±1.1 to 0±0 postoperatively. In 8 patients who underwent horizontal surgery alone, the preoperative vertical deviation improved from 1.3±1.7 to 0.10.3.
Discussion: SES may be associated with small non-restrictive vertical deviation and excylotorsion. Small vertical deviations can be corrected with horizontal surgery alone. Larger deviations may require simultaneous selective vertical muscle procedures.
Conclusion: Acquired vertical deviations may result from connective tissue disorders as seen in patients with SES. Surgical planning may require operation on the vertical rectus muscles.
References: 1. Demer JL. The Apt Lecture. Connective tissues reflect different mechanisms of strabismus over the life span. J AAPOS. 2014;18(4):309-315.
- L. Pansara M, B. Granet D, Kinori M, C. Acera E, Robbins S. Inferior rectus and superior rectus displacement in heavy eye syndrome (hes) and saggy eye syndrome (SES). Vol 212017.
- Chang MY, Pineles SL, Velez FG. Adjustable small-incision selective tenotomy and plication for correction of incomitant vertical strabismus and torsion. J AAPOS. 2015;19(5):410-416.