Age-related changes in the orbital pulley array of older Japanese adults with acquired exotropia.

Cross-sectionalGraefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie· Jun 2026

Age-related changes in the orbital pulley array of older Japanese adults with acquired exotropia.

Reika Kono, Ichiro Hamasaki, Fumiko Kishimoto … Yuki Morizane

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Pediatric OphthalmologyCross-sectionalQ1IF 3.1

Most older adults with exotropia had a ruptured band linking two eye muscles.

Age-related changes in the orbital pulley array of older Japanese adults with acquired exotropia.

Reika Kono … Yuki Morizane

Graefe's archive for clinical and experimental ophthalmology · Jun 2026 · Q1 in Ophthalmology

Purpose

To evaluate age-related changes in the orbital pulley array using magnetic resonance imaging (magnetic resonance imaging) in older Japanese adults with acquired exotropia (XT) compared with young healthy participants (young healthy participants).

Methods

In this retrospective cross-sectional case series, magnetic resonance imaging images of 30 eyes from fifteen patients (age ≥ 60 years) with distance XT and no high myopia were compared with those of 14 eyes from seven young healthy participants.

n = 30 eyes

Results

80.0%

in most eyes checked, the band linking two eye muscles was torn

n = 30 eyes

More results

Mean age of patients with XT was 73.7 ± 5.5 years.

More results

Compared with young healthy participants, patients with XT showed significant inferior displacement of the lateral rectus (lateral rectus) pulley (-3.6 ± 1.2 mm vs. - 2.0 ± 1.1 mm, p < 0.01) and temporal displacement of the superior rectus (superior rectus) pulley (-0.4 ± 1.2 mm vs. - 1.6 ± 0.8 mm, p < 0.01).

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Conclusion · 1 of 2

Older Japanese adults with XT exhibit localized pulley displacement and LR-SR band rupture.

Conclusion · 2 of 2

These structural changes differ from the global sagging observed in sagging eye syndrome and may contribute to the pathogenesis of acquired exotropia in older adults.

Age-related changes in the orbital pulley array of older Japanese adults with acquired exotropia.

Age-related changes in the orbital pulley array of older Japanese adults with acquired exotropia.

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