Connective tissues reflect different mechanisms of strabismus over the life span

1. The article discusses the role of connective tissue pulleys in determining extraocular muscle force directions and how pulley abnormalities can lead to strabismus (eye misalignment).

2. Magnetic resonance imaging (MRI) was used to study 95 patients with pulley heterotopy, including 56 with childhood-onset pattern strabismus, and compared to 28 patients with sagging eye syndrome and age-matched control subjects.

3. Childhood-onset strabismus was associated with A or V pattern strabismus and abnormal rectus pulley positions, likely congenital in origin.

4. Surgical correction for childhood-onset pulley heterotopy often required transpositions of rectus muscles but could induce adverse torsion.

5. Adult-onset pulley heterotopy in sagging eye syndrome was characterized by external signs of adnexal laxity, including blepharoptosis and superior lid sulcus defects, and was linked to age-related connective tissue degeneration.

6. MRI findings showed significant lateral and inferior displacement of rectus pulleys in sagging eye syndrome, as well as tilting of the lateral rectus muscle.

7. The article highlights the importance of understanding pulley abnormalities in the etiology and treatment of strabismus, both in childhood and adult-onset cases.