Body Mass Index Is Associated With Orbital Pulley Degeneration Syndrome, Including Sagging Eye Syndrome.

Abstract

Sagging eye syndrome (SES), esotropia with high myopia including heavy eye syndrome, and age-related esotropia (ARE)-collectively termed orbital pulley degeneration syndrome (OPDS)-are characterized by strabismus with orbital pulley lateral rectus-superior rectus band impairment. Herein, we examined body mass index (BMI) in OPDS to determine SES-associated anthropometric characteristics. Retrospective cohort study. We compiled and analyzed the BMI of patients aged ≥50 years who underwent strabismus surgery at a single center in Shizuoka, Japan, between July 2020 and March 2023. BMI (kg/m²) was categorized into 4 groups: <18.5, 18.5 to 21.9, 22 to 24.9, and ≥25. As the boundary between OPDS and SES is ambiguous, we assumed a pure SES group by excluding patients with ARE and esotropia with high myopia from the OPDS group. Overall, 204 patients (age: 67.7 ± 9.7 years) were included in the study. There were 78/126 and 49/119 patients in the OPDS/non-OPDS and SES/non-SES groups (age: 70.4 ± 9.5/66.0 ± 9.6 years, P = .002 and 75.0 ± 6.0/66.6 ± 9.5 years, P < .001; BMI: 21.2 ± 3.3/23.2 ± 3.0 kg/m², P < .001 and 21.2 ± 3.3/23.1 ± 3.0 kg/m², P = .003), respectively. In the BMI-stratified analysis, OPDS and SES were more prevalent in the <18.5 BMI group than in the 22 to 24.9 and ≥25 BMI groups (P < .001 and P = .006, respectively). Logistic regression analysis, adjusted for age and sex, showed that lower BMI was associated with a higher prevalence of OPDS and SES. Patients with OPDS, including SES, had lower BMI than other patients with strabismus. Therefore, BMI may be a clinical clue to SES.