Inferior rectus displacement in heavy eye syndrome and sagging eye syndrome

• Published in: Graefe's archive for clinical and experimental ophthalmology 2020-05, Vol.258 (5), p.1109-1113
• Main Authors: Kinori, Michael, Pansara, Megha, Mai, Derek D., Robbins, Shira L., Hesselink, John R., Granet, David B.
• Format: Article
• Language: English
• Subjects: Adult; Age; Aged; Aged, 80 and over; Eye Movements - physiology; Female; Humans; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Muscles; Myopia - diagnostic imaging; Myopia - physiopathology; Neuroimaging; Neurophthalmology; Oculomotor Muscles - diagnostic imaging; Oculomotor Muscles - physiopathology; Ophthalmology; Retrospective Studies; Strabismus - diagnostic imaging; Strabismus - physiopathology
• ISSN: 0721-832X; 1435-702X
• DOI: 10.1007/s00417-020-04629-4

Purpose To evaluate if there is a nasal displacement of the vertical rectus muscles in heavy eye syndrome (HES) and/or sagging eye syndrome (SES) compared with age-matched controls. Methods We reviewed the charts of all patients with the diagnosis of HES or SES who were seen at the University of California San Diego (UCSD) between the years 2008–2016 who underwent magnetic resonance imaging (MRI) of the brain and orbits. The control group included patients who had brain and orbital MRIs at UCSD in the absence of known pathology in the orbits or globes. Measurements were taken by 3 separate examiners for all groups. Results Twenty-four patients (16 with SES and 8 with HES) and 24 age-matched controls were retrospectively reviewed. The superior rectus (SR) of patients with HES and SES was more nasally displaced from the midline compared with that of age-matched controls ( p  = 0.04, p  = 0.03, respectively). The inferior rectus (IR) of patients with HES but not with SES was more nasally displaced from the midline compared with that of age-matched controls ( p  = 0.04, p  = 0.62, respectively). In all groups, the IR nasal displacement from the midline was approximately double compared with the SR. Conclusions There is a significant nasal displacement of the SR in HES and SES and IR in HES. The observed IR nasal displacement in HES is a new finding and may explain the residual hypotropia and/or esotropia following surgical interventions for HES not involving the IR.