Age-related orbital connective tissue degeneration may manifest as saggy eye syndrome (SES) in the upper eyelid or as intermittent exotropia (IXT) in the lower eyelid, according to a study published in the American Journal of Ophthalmology.
Researchers enrolled 86 participants (mean age, 72.7 years; 45 men) in a retrospective, cross-sectional study and stratified them according to disease status. Patients with SES (n=23; 30% men), IXT group (n=28; 79% men) and control individuals (n=35; 46% men) were included in the analysis. A team of 3 ophthalmologists compared facial photographs among the participants and evaluated each eye for sunken upper eyelid, blepharoptosis, and baggy lower eyelid using a scoring scale.
Sunken upper eyelid scores were significantly higher among participants in the SES group compared with participants in both the control and IXT groups (P < .001). Baggy lower eyelid scores were significantly higher among participants in the IXT group compared with control individuals (P < .05) and there were no significant differences between IXT and SES group participants. No significant differences in blepharoptosis scores were noted among the 3 groups, according to the report.
“The pathogenesis of age-related sunken upper eyelid is caused by changes in the orbital connective tissue, especially collagen, whereas SES develops due to atrophy of the pulley, which also exhibits age-related changes,” according to researchers.
Study limitations include a small sample size and homogeneity among the cohort.
Kunimi K, Goseki T, Fukaya K, Takahashi S, Ishikawa E. Analysis of facial features of patients with sagging eye syndrome and intermittent exotropia compared to controls. Am J Ophthalmol. Published online October 18, 2022. doi:10.1016/j.ajo.2022.10.007