Case report on heavy eye syndrome

Abstract

In high myopia, acquired esotropia can be present as strabismus fixus convergence also known as Heavy Eye Syndrome (HES). Although exotropia and hypertropia have been reported, patients typically present with diplopia due to increasing esotropia and hypotropia with limitations on abduction and elevation. We reported two cases of HES based on history and clinical examination, which includes anterior and posterior segment examination and squint evaluation. The MRI of both patients showed displacement of lateral rectus inferiorly and nasal shifting of superior rectus. In both the cases forced duction test (FDT) was positive for affected medial rectus (MR) when performed under local anaesthesia. Subsequently, they underwent loop myopexy of superior rectus (SR) with medical rectus (MR) along with MR recession for affected eye. Postoperatively, Case 1 had a residual esotropia of 18 prism dioptre (PD) and case 2 had 40 PD compare to preoperatively 70 and 80 PD respectively, measured with the krimsky test. Axial length lengthening and herniation of sclera between the SR and LR muscles are the two main contributors to HES. To stop additional herniation, the inter-muscular link must be restored. Loop myopexy is an elegant and effective procedure to achieve good cosmetic and functional results for HES.