Binocular diplopia can be one of the most challenging presentations for an OD—you have to be prepared for anything. An incorrect prescription, binocular vision disorder, orbital disease and cranial nerve palsies can all be to blame.1-3 But have you ever considered something as simple as the eyelids? According to new research from UCLA’s Stein Eye Institute, you should. The team found sagging eyelid syndrome (SES), a new clinical finding first described just 10 years ago, is the underlying etiology for 31.4% of binocular diplopia cases.4

The team reviewed the medical records of 945 patients aged 40 or older who presented to the clinic with binocular diplopia. The 297 patients diagnosed with SES tended to be older, with a mean age of 71.2 (the average for the entire cohort was 66.5) and more than half, 59.9%, were women. Age was a significant factor in the diagnosis of SES, considering only 4.7% of the diplopia patients younger than 50 were ultimately diagnosed with SES while 60.9% of those over the age of 90 had SES to blame for their double vision.

In addition, 35% of the SES cases had age-related esotropia, and 65% had cyclovertical strabismus. Strabismus surgery successfully resolved the diplopia for the 50.2% who underwent the procedure.

“It is important to recognize that SES is a very common cause of adult binocular diplopia,” the researchers noted in their study. While a simple conclusion, it could have significant implications for your diplopia differential.  

1. Mashige KP, Munsamy AJ. Diplopia. South African Family Practice. 2015;58(sup1):S12-17.

2. Rucker JC, Tomsak RL. Binocular diplopia. The Neurologist. 2005;11(2):98-110.

3. Peragallo J, Newman N. Diplopia—an update. Sem Neurol. 2016;36(4):357-61.

4. Goseki T, Suh SY, Robbins L, et al. Prevalence of sagging eye syndrome in adults with binocular diplopia. Am J Ophthalmol. September 14, 2019. [Epub ahead of print].