Adult-onset nonparalytic, small-angle hypertropia

Saumya M. Shah, Jennifer M. Martinez-Thompson, Nancy N. Diehl, Brian G. Mohney

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


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 2Δ (range, 1Δ-22Δ) at near and 2Δ (range, 0Δ-12Δ) 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 4Δ (range, 0Δ-20Δ) at near and 4Δ (range, 0Δ-16Δ) 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 ≤10Δ that progressed over time.

Original languageEnglish (US)
Pages (from-to)438-440
Number of pages3
JournalJournal of AAPOS
Issue number6
StatePublished - Dec 2018

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Ophthalmology


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