Systemic and Metabolic Profile of Sagging Eye Syndrome: A Comparative Analysis

Sagging eye syndrome (SES) is an acquired strabismus characterized by distance esotropia (ET) and cyclo-vertical deviation, affecting older people. This study identified demographic, systemic, and ocular factors associated with SES and compared them to other forms of ET in older adults.

Retrospective cohort study.

Demographic data, systemic comorbidities, ocular history, and strabismus were reviewed in esotropic patients at least 55 years old diagnosed with SES between 2013 and 2024 at a single institution, and compared with age-matched controls diagnosed with other forms of ET.

A total of 383 patients were studied, of whom 67 had SES, and 316 had ET without SES ET. Male SES patients were significantly older at 81.5 ± 10 years (standard deviation) than esotropic males without SES at 76 ± 10 years (P = .04), and symptom onset was significantly older for SES in both genders (male: 72 ± 10 years vs 68 ± 11 years, P = .02; female: 75 ± 9 years vs 69 ± 9 years, P = .04). Women with SES had significantly lower mean body mass index (BMI) at 23 ± 4 than esotropic women without SES at 25 ± 5 (P = .02). Logistic regression demonstrated that lower BMI was associated with higher odds of SES in women, with the odds of SES increasing by approximately 9.4% for each 1-unit decrease in BMI (odds ratios = 0.91, 95% confidence intervals [CI]: 0.84-0.99). Osteopenia was more prevalent at 77% among esotropic women with SES than women without osteopenia at 51% (P = .003), and remained an independent risk factor for SES after adjusting for age (odds ratios = 1.81, 95% CI: 1.02-3.23, P = .04) and BMI (95% CI, 1.14-6.18; P = .02). There were no significant differential associations with SES for gender, smoking, alcohol use, hypertension, hyperlipidemia, type 2 diabetes, cataract surgery, glaucoma, or use of progressive addition spectacles.

SES is associated with advanced age at symptom onset in both genders and with lower BMI and osteopenia in women.