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Purpose: To describe the prevalence and clinical features of a common but underrecognized disorder of adult vertical strabismus., Methods: The medical records of all adult (≥19 years of age) residents of Olmsted County, Minnesota, diagnosed with nonparalytic, small-angle hypertropia (NPSAH) from January 1, 1985, through December 31, 2004, were retrospectively reviewed for demographic and clinical features., Results: Of 753 patients diagnosed with adult-onset strabismus, 99 (13.1%) were found to have NPSAH, yielding an annual incidence of 7.50 per 100,000 patients >18 years of age and a cumulative incidence of 1.28%. The median age at diagnosis was 71 years (range, 27-98 years); 63 (64%) were women. Diplopia was reported at the initial diagnosis in 91 patients (93.8%), with 90 (92.8%) having the diplopia in primary or reading position. The median initial angle of hypertropia was 2 Δ (range, 1 Δ -22 Δ ) at near and 2 Δ (range, 0 Δ -12 Δ ) at distance. After a median follow-up of 10.8 years (range, 6.2 months to 23.7 years), the final median angle of vertical deviation was 4 Δ (range, 0 Δ -20 Δ ) at near and 4 Δ (range, 0 Δ -16 Δ ) at distance for all 99 patients., Conclusions: NPSAH is a relatively common but infrequently recognized disorder among adults. More prevalent among elderly and female patients in this study cohort, the vast majority presented with diplopia and a hypertropia of ≤10 Δ that progressed over time., (Copyright © 2018 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.) more...

Objective: To describe the incidence and types of adult-onset strabismus in a geographically defined population., Design: Retrospectively reviewed population-based cohort., Participants: All adult (≥19 years of age) residents of Olmsted County, Minnesota, diagnosed with new-onset adult strabismus from January 1, 1985, through December 31, 2004., Methods: The medical records of all potential cases identified by the resources of the Rochester Epidemiology Project were reviewed., Main Outcome Measures: Incidence rates for adult-onset strabismus and its types., Results: Seven hundred fifty-three cases of new-onset adult strabismus were identified during the 20-year period, yielding an annual age- and gender-adjusted incidence rate of 54.1 cases (95% confidence interval, 50.2-58.0) per 100 000 individuals 19 years of age and older. The 4 most common types of new-onset strabismus were paralytic (44.2% of cases), convergence insufficiency (15.7%), small-angle hypertropia (13.3%), and divergence insufficiency (10.6%). The incidence of adult-onset strabismus overall and its 4 most common forms significantly increased with age (P <0.001 for all), with a peak incidence in the eighth decade of life. The lifetime risk of being diagnosed with adult-onset strabismus was 4.0% in women and 3.9% in men., Conclusions: Paralytic strabismus was the most common subtype of new-onset adult strabismus in this population-based cohort. All of the most common forms of adult-onset strabismus increased with age, especially after the sixth decade of life. Further characterization of strabismus types found in this study is warranted to better define this disorder., (Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.) more...