Exotropia, Saggy Eye Syndrome May Reveal Orbital Connective Tissue Degeneration

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.