PURPOSE-In axial high myopes with "heavy eye" syndrome, orbital magnetic resonance imaging (MRI) demonstrates degeneration of the lateral rectus-superior rectus (LR-SR) band, so that the lateral rectus muscle slips inferiorly to produce esotropia and hypotropia. We asked if this degeneration might also cause strabismus in nonmyopic elderly patients. METHODS-Three strabismic elderly patients, three strabismic high myopes, and 12 orthotropic elderly subjects underwent ophthalmic examinations and orbital MRI. Lateral rectus position was determined relative to globe center from quasicoronal images and correlated with LR-SR band structure. MRI was compared to histology of four cadaveric orbits ranging in age from 17 months to 93 years. RESULTS-Two strabismic patients exhibited hypotropia and one exhibited esotropia. Their mean axial length was 24.1 ± 0.8 mm (mean ± SD), compared to 31.6 ± 1.4 mm for myopes. The lateral rectus muscle position of elderly strabismic subjects averaged 4.6 ± 1.7 mm inferior to globe center, which was significantly lower than that of orthotropic elderly subjects (2.1 ± 1.9 mm; P = 0.01) and similar to that of high myopes (5.1 ± 3.2 mm). By MRI, 100% of strabismic elderly orbits, 67% of strabismic myopic orbits, and 12.5% of control elderly orbits showed LR-SR band thinning, discontinuity, or displacement. LR-SR band degeneration was present histologically only in older cadavers. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. CONCLUSION-Age-related LR-SR band degeneration permits the lateral rectus muscle to slip inferiorly in elderly non-myopes, a mechanism of strabismus similar to myopic "heavy eye" syndrome. Imaging may assist in diagnosing this mechanical cause of age-related strabismus. NIH Public Access

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After 6 biannual mass distributions of oral azithromycin for trachoma in Ethiopian communities, 76.8% (95% confidence interval [CI], 66.3%-85.1%) of nasopharyngeal Streptococcus pneumoniae isolates from children aged 1-5 years were resistant to macrolides. Twelve and 24 months after the last azithromycin treatment, resistance decreased to 30.6% (95% CI, 18.8%-40.4%; P <.001 ) and 20.8% (95% CI, 12.7%-30.7%; P < .001), respectively. Macrolide resistance decreases after antibiotic pressure is removed.

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