Orbital magnetic resonance imaging is useful in age-related distance esotropia

Abstract Purpose To describe findings for orbital magnetic resonance imaging (MRI) in patients with age-related distance esotropia (ARDE). Methods We compared 31 orbital MRI from patients with ARDE (77 ± 7 SD years) with 2 control groups: 32 orbits from individuals aged 18–50 years (33 ± 8 SD years) and 16 orbits from individuals aged >60 years (77 ± 7 SD years). MRI scans were acquired using 3D fast field echo in T1 sequence without fat saturation. Exclusion criteria for all groups were neurological or thyroid disease and a relevant ophthalmological history (e.g., high myopia, diplopia from another etiology, complicated cataract surgery, etc.). Muscle displacement and characteristics of the lateral rectus–superior rectus (LR–SR) intermuscular band were analyzed. Results The analysis of the muscles and angles revealed a series of statistically significant differences ( p < 0.07) between the groups. Subjects with ARDE had LR pulley positions 1.32 ± 0.19 mm lower than in younger controls, and the medial rectus (MR) pulley positions were 0.68 ± 0.19 mm lower than in younger. Older controls had LR and MR pulley positions 0.85 ± 0.20 mm and 0.49 ± 0.23 mm lower than in younger. ARDE subjects had LR pulley positions 0.46 ± 0.26 mm lower than in older control group. The LR–SR band was absent in 35.5% of ARDE patients and in 12.5% of older control group ( p = 0.168). Conclusions MRI showed that displacements of LR and LR–SR band degeneration could facilitate the diagnosis of patients with ARDE.