Prevalence of Sagging Eye Syndrome in Adults with Binocular Diplopia.

Sagging eye syndrome (SES), horizontal and/or vertical strabismus caused by orbital connective tissue degeneration, was first defined 10 years ago. In this study, we investigated the causes of acquired binocular diplopia in adults presenting to single institution since the description of SES.Retrospective observational case series.We reviewed medical records of all new patients over age 40 years who presented to the Stein Eye Institute with binocular diplopia between January 2015 and December 2018. We tabulated clinical causes of diplopia in patients grouped by age and gender. In patients with SES, we tabulated binocular alignment, types of treatment, and surgical outcomes.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 about 4.7% under age 50 years, to about 60.9% over age 90 years. Age-related distance esotropia was present in 35% of cases of SES. Cyclovertical strabismus was present in 65% of SES cases. Strabismus surgery was performed in 50.2% of cases of SES. Mean esotropia at distance decreased from 6.9±0.7Δ pre-operatively to 0.3±0.3Δ post-operatively. Pre-operative hypertropia decreased from 3.0±0.3Δ to 0.7±0.2Δ post-operatively. Surgery resolved diplopia in all cases.It is important to recognize that SES is a very common cause of adult binocular diplopia.