Analysis of Facial Features of Patients With Sagging Eye Syndrome and Intermittent Exotropia Compared to Controls.

PURPOSE: To compare the facial features of patients with sagging eye syndrome (SES) and other ophthalmic diseases, and to evaluate the diagnostic usefulness of facial features for SES. DESIGN: Retrospective cross-section study. METHODS: We evaluated frontal facial photographs of patients >60 years of age with SES and intermittent exotropia (IXT), and control patients who visited the ophthalmology outpatient clinics of 2 institutions between June 2020 and December 2021. Three ophthalmologists evaluated each eye for sunken upper eyelid, blepharoptosis, and baggy lower eyelid, using a scoring scale. The average scores for each parameter among the 3 groups were analyzed. Patients with glaucoma, visual acuity <16/20, SES with a vertical strabismus angle of ≥6 Δ, IXT that could not be maintained in the phoria position during photography, a history of previous oculoplastic or ophthalmic surgery, and use prostaglandin analogs for cosmetic purposes were excluded. RESULTS: A total of 86 patients were included: 23 with SES, 28 with IXT, and 35 in the control group. All were Japanese. In all, 45 patients were male and 41 were female. The mean age was 72.7 ± 7.4 years. The sunken upper eyelid scores were significantly higher in the SES group than in the control and IXT groups (P < .001), whereas the baggy lower eyelid scores were significantly higher in the IXT group than in the control group (P < .05). CONCLUSIONS: Age-related orbital connective tissue degeneration may manifest as SES in the upper eyelid and as IXT in the lower eyelid.

New device for taking nine-directional ocular photographs: "9Gaze" application.

This study compared the time required to produce nine-directional ocular photographs using the conventional method to that using the newly devised 9Gaze application. In total, 20 healthy adults, 10 adult patients with strabismus, and 10 pediatric patients with amblyopia or strabismus had their ocular photographs taken using a digital camera with PowerPoint 2010, and with an iPad, and iPod touch with 9Gaze. Photographs of 10 healthy patients were taken by orthoptists with <1 year of experience, and the other participants had theirs taken by those with >1 year of experience. The required time was compared between the three devices in all patients and the two orthoptist groups in 20 healthy adults (>1 year and <1 year of experience). The required times were significantly different between the devices: 515.5 ± 187.0 sec with the digital camera, 117.4 ± 17.8 sec with the iPad, and 76.3 ± 14.1 sec with the iPod touch. The required time with the digital camera was significantly different between the two orthoptist groups (404.7 ± 150.8 vs. 626.3 ± 154.2 sec, P=0.007). The use of the 9Gaze application shortened the recording time required. Furthermore, 9Gaze can be used without considering the years of experience of the examiner.