Department of Ophthalmology, Kitasato University, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
Department of Ophthalmology, International University of Health and Welfare, Atami Hospital, 13-1 Higashi-kaigan-cho, Atami-City, Shizuoka, 413-0012, Japan.
Jpn J Ophthalmol. 2021 Jul;65(4):448-453. doi: 10.1007/s10384-021-00839-3. Epub 2021 May 20.
The pulley is the functional origin of the extraocular muscles and prevents their dislocation from the muscle cone. The pulley degenerates with age and may progress to cause the sagging eye syndrome (SES). Divergence paralysis, a type of distance esotropia, occurs when the lateral rectus muscle pulley and lateral rectus-superior rectus (LR-SR) band show degenerated symmetry OU. Cyclovertical strabismus of a small angle occurs when the lateral rectus muscle pulley and LR-SR band show degenerated asymmetry OU. Patients with SES have distinctive features, such as baggy eyelids, deep superior sulcus deformity, and aponeurotic ptosis. SES is the leading cause of non-paralytic diplopia, and its rate increases with age, with 60% of the patients being women. One-third of the cases of SES are distance esotropia of 9Δ on average, and two-third of the cases are small-angle hypertropia of 4Δ on average. Diplopia is cured with surgery, and each case needs to be differentiated from the heavy eye syndrome for diagnosis and treatment.
滑车是眼外肌的功能起源，可防止其从肌圆锥脱位。滑车随年龄退化，可能进展导致脱垂眼综合征（SES）。当外侧直肌滑车和外侧直肌-上直肌（LR-SR）带出现退化对称 OU 时，会发生外展麻痹，这是一种远距离内斜视。当外侧直肌滑车和 LR-SR 带出现退化不对称 OU 时，会发生小角度的垂直性斜视。SES 患者具有明显特征，如眼睑松弛、深上睑沟畸形和腱膜性上睑下垂。SES 是引起非麻痹性复视的主要原因，其发生率随年龄增长而增加，女性患者占 60%。SES 患者中有三分之一平均为 9Δ 的远距离内斜视，三分之二为平均 4Δ 的小角度高斜视。复视可以通过手术治愈，每个病例都需要与重症肌无力综合征相区别，以进行诊断和治疗。
