"Unlike heavy eye syndrome, the vast majority of patients with sagging eye syndrome do not have high axial myopia, although this can occur 3."
"increased angle angle between superior rectus and inferior rectus (~100°), but reduced relative to heavy eye syndrome (may be >120°) 3"
"migration of intraorbital fat fat and/or the lacrimal gland into the superotemporal orbit (as viewed on coronal slices) 3"
"Sagging eye syndrome becomes more common with ageing, with a median age of ~70 years 1,2. It is a common cause for diplopia outpatient referrals in adults (>40 years old), accounting for approximately one-third of referrals in one centre 2. There is no gender predilection 9."
"Sagging eye syndrome is thought to be a consequence of ageing, that results in degeneration or involution of orbital connective tissue 1,2,5. In particular, the ligament interconnecting the superior border of the lateral rectus (LR) pulley and lateral border of the superior rectus (SR) pulley, the LR-SR band, is affected, typically bilaterally 1,2,5. Degeneration of the LR-SR band causes it to progressively elongate and thin, with eventual rupture in some patients 1,2,5. This results in progressive inferior sagging of the LR pulley, causing the clinical features of esotropia and/or cyclovertical strabismus, the latter depending on the degree of asymmetry between the displacement of the LR pulley on either side 1."
"thinning, elongation, disruption or rupture, of the LR-SR band 1-3"