Magnetic resonance imaging findings of age-related distance esotropia in Japanese patients with high myopia

  • Reika KonoEmail author
  • Hiroshi Ohtsuki
  • Fumiko Kishimoto
  • Ichiro Hamasaki
  • Yuki Morizane
  • Fumio Shiraga



This study aimed to investigate the characteristics of the extraocular muscles and the orbital connective tissue pulleys in Japanese patients with age-related distance esotropia (ARDE) and high myopia using magnetic resonance imaging (MRI).


This was a retrospective case-series study. High-resolution coronal MRI scans of 12 orbits were obtained in 6 patients with ARDE and high myopia (age range: 51–69 years). We analyzed the images to determine the positions of the rectus muscle pulleys relative to the center of the globe, the integrity of the lateral rectus-superior rectus muscle (LR-SR) band, and the LR angle (the angle between the major axis of the LR and the vertical plane).


The distance esotropia ranged from 4 to 25∆, and 3 cases exhibited vertical deviations. The mean (±standard deviation (SD)) axial length was 28.5 (± 1.6) mm. The mean positions of the medial rectus muscle pulley and LR pulley were 1.3 mm inferior and 1.4 mm inferior, respectively, to those seen in the normal control group in our previous study (P = 0.002 and P = 0.05, respectively). All 12 orbits had abnormal elongated LR-SR bands, and 8 orbits (67%) displayed ruptured LR-SR bands. The LR angle (mean±SD; 18.8° ± 8.5°) increased significantly with the inferior displacement of the LR pulley (R2 = 0.77, P = 0.0002).


Inferior displacement of the LR pulley and abnormal LR-SR bands were seen in Japanese ARDE patients with high myopia, as was found in ARDE patients without high myopia. The LR angle might be useful for judging the degree of LR pulley displacement.


Age-related distance esotropia Esotropia High myopia Orbital pulley Sagging eye syndrome 


Compliance with ethical standards

Conflicts of interest

Fumio Shiraga received grants from Santen Pharmaceutical and Alcon Pharmaceutical. The sponsors had no control over the interpretations, writing, or publication of this study. The other authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were carried out in accordance with the ethical standards of the ethics committee of Okayama University Hospital and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. This stud’s approval number is K1507-021.

Informed consent

Informed consent was obtained from all participants included in this study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Ophthalmology, Medical SchoolOkayama UniversityOkayama CityJapan
  2. 2.Division of OphthalmologyOkayama Saiseikai General HospitalOkayamaJapan
  3. 3.Division of OphthalmologyIbara City HospitalIbaraJapan
  4. 4.Department of OphthalmologyOkayama University HospitalOkayamaJapan
  5. 5.Department of OphthalmologyOkayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesOkayamaJapan

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