Sagging eye syndrome: connective tissue involution as a cause of horizontal and vertical strabismus in older patients.
Sagging eye syndrome: connective tissue involution as a cause of horizontal and vertical strabismus in older patients.
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DOI：
10.1001/jamaophthalmol.2013.783
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发表时间：
2013-05
影响因子：
8.1
通讯作者：
Demer, Joseph L.
中科院分区：
文献类型：
--
作者：
Chaudhuri, Zia;Demer, Joseph L.
认识到眼下垂综合征（SES）作为慢性或急性获得性复视的原因，在大多数情况下可以避免神经学评估和影像学检查。目的：探讨斜视是否由外侧直肌（LR）眼外肌（EOM）滑车下移位引起，并探讨斜视的解剖学相关性。我们在一家眼科研究所使用磁共振成像来评估直肌EOMs、滑轮和LR -上直肌（SR）带韧带。怀疑患有SES的获得性复视患者。我们研究了临床诊断为SES的11名男性和17名女性的56个眼眶（平均[SD]年龄为69.4[11.9]岁）。数据来自年龄与SES相匹配的14名对照参与者的25个轨道和28名年轻对照（23[4.6]岁）的52个轨道。直肌滑轮位置与年龄匹配的标准和长度的LR-SR韧带和直肌EOMs的比较。数据与面部特征、双眼对准和眼底扭转相关。SES患者通常表现为上睑下垂和上沟缺损。在SES中证实了明显的下外侧直肌滑轮位移，但异常范围扩展到所有其他直肌滑轮的外周位移和下直肌滑轮的外侧位移，以及直肌EOMs的伸长（P < 0.001）。对称性外视凹陷与发散性麻痹性内斜视有关，不对称外视凹陷大于1mm与环形垂直斜视有关。91%的SES患者的LR-SR带破裂。广泛的直肌滑轮位移和EOM延伸，与LR-SR带断裂有关，导致获得性垂直和水平斜视。小角度内斜视或远视可能是由眼膜和眼窝结缔组织共同的交替变化引起的，这可以从外部检查的明显特征中怀疑。
Recognition of sagging eye syndrome (SES) as the cause of chronic or acute acquired diplopia may avert neurologic evaluation and imaging in most cases. To determine whether SES results from inferior shift of lateral rectus (LR) extraocular muscle (EOM) pulleys and to investigate anatomic correlates of strabismus in SES. We used magnetic resonance imaging to evaluate rectus EOMs, pulleys, and the LR– superior rectus (SR) band ligament at an eye institute. Patients with acquired diplopia suspected of having SES. We studied 56 orbits of 11 men and 17 women (mean [SD] age of 69.4 [11.9] years) clinically diagnosed with SES. Data were obtained from 25 orbits of 14 control participants age-matched to SES and from 52 orbits of 28 younger controls (23[4.6] years). Rectus pulley locations compared with age-matched norms and lengths of the LR-SR band ligament and rectus EOMs. Data were correlated with facial features, binocular alignment, and fundus torsion. Patients with SES commonly exhibited blepharoptosis and superior sulcus defect. Significant infero-lateral LR pulley displacement was confirmed in SES, but the spectrum of abnormalities was extended to peripheral displacement of all other rectus pulleys and lateral displacement of the inferior rectus pulley, with elongation of rectus EOMs (P < .001). Symmetrical LR sag was associated with divergence paralysis esotropia and asymmetrical LR sag greater than 1mm with cyclovertical strabismus. The LR-SR band was ruptured in 91% of patients with SES. Widespread rectus pulley displacement and EOM elongation, associated with LR-SR band rupture, causes acquired vertical and horizontal strabismus. Small-angle esotropia or hypertropia may result from common involutional changes in EOMs and orbital connective tissues that may be suspected from features evident on external examination.
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影响因子：
1.2
作者：
Lefevre, F.;Leroy, K.;Pechereau, A.
通讯作者：
Pechereau, A.
影响因子：
--
作者：
Chaudhuri, Zia;Demer, Joseph L.
通讯作者：
Demer, Joseph L.
影响因子：
4.4
作者：
Demer, JL;Oh, SY;Poukens, V
通讯作者：
Poukens, V
影响因子：
--
作者：
Clark, Robert A.;Demer, Joseph L.
通讯作者：
Demer, Joseph L.
影响因子：
1.6
作者：
Rutar, Tina;Demer, Joseph L.
通讯作者：
Demer, Joseph L.