Strabismus in patients over the age of 60 years

We studied all cases of strabismus surgery performed at the Manhattan Eye, Ear and Throat Hospital between January 1, 1981 and June 30, 1986. Of the procedures, 106 (5.4%) were performed on patients over the age of 60 years. Strabismus in patients over age 60 represents a category of diseases which are different from those of childhood. Horizontal deviations were seen in 74% of the patients equally divided between esotropia and exotropia. Vertical strabismus was seen in 17%, and a combined vertical horizontal strabismus was seen in 9% of patients. In children, the overwhelming majority of ocular deviations are horizontal, with esotropias outnumbering exotropias. The strabismus was of adult onset in 71% of cases and of childhood onset in 29% of the patients. The etiology in the adult onset strabismus group included neuroparalytic, restrictive, sensory, and post-cataract surgery strabismus, as well as decompensated exophoria/intermittent exotropia; this was in contrast to children where the most common etiology of strabismus is innervational disturbances in fusional vergences. The major indications for surgery were diplopia and aesthenopia in 71% of cases. Diplopia is uncommon in childhood. Corrective surgery for the relief of diplopia may be enhanced with the use of adjustable sutures and postoperative prism therapy. Precise realignment is the goal of strabismus surgery in all age groups, however, the role of adjustable sutures and prisms is more important in the treatment of the functional complaints of older patients. Exploration and lysis of adhesions and scar tissue are major components of surgery on patients with restrictive strabismus.(ABSTRACT TRUNCATED AT 250 WORDS)