Abstract
Aim To provide an overview of the differential diagnoses of acquired esotropia that occur
in the elderly and to facilitate their differentiation in everyday clinical practice.
Methods The data of all patients who presented in our outpatient university department for
strabology and neuroophthalmology from March 2014 to October 2015 due to esotropia
with diplopia with onset after age 50 were evaluated retrospectively. Exclusion criteria
were a known strabismus before the age of 50 and/or vertical deviations in the primary
position. Anamnestic characteristics, accompanying findings and orthoptic parameters,
were analysed.
Results 85 patients were included in the study, 42 of them female and 43 male. The following
diagnoses were made: abducens nerve palsy (n = 34, 3 of them both sides), esotropia
due to myopia magna (n = 12), esotropia with accompanying neurological symptoms (n = 6)
and other etiology (n = 5). In 4 cases, the diagnosis was still unclear at the end
of the study. In 24 patients, none of the above diagnoses existed and the diagnosis
of “sagging eye syndrome” (ETSAG) was made. The abducens nerve palsy typically showed
a sudden onset of double vision, slowed abduction saccades and asymmetrical abduction
ability. With unilateral abducens nerve palsy, the esotropia increased continuously
from the view to the unaffected side through the primary position to the view to the
affected side. Patients with ETSAG and myopia-associated esotropia, on the other hand,
reported a gradual onset of double vision, showed normal abduction saccades and a
slightly reduced abduction ability.
The squint angle often increased slightly to both sides. Esotropia with accompanying
neurological symptoms was rare and was seen in various underlying diseases.
Conclusions The kind of onset of the double vision, the quality of the saccades, the incomitance
pattern and the ability to abduct are important parameters for the etiological assignment
of an esotropia in the elderly. The characteristics of the individual diagnoses are
described and differential diagnostic aspects are discussed.
Key words
neuroophthalmology - strabismus - esotropia - elderly - diplopia
