2020–2021 BCSC Basic and Clinical Science Course™
6 Pediatric Ophthalmology and Strabismus
Part I: Strabismus
Chapter 12: Special Motility Disorders
Miscellaneous Special Forms of Strabismus
Esotropia and Hypotropia Associated With High Myopia
In highly myopic patients, extremely increased axial length can cause the elongated globe to herniate between the superior and lateral rectus muscles. High-resolution MRI studies have shown stretching and dehiscence of the intermuscular septum between these 2 muscles. They have also demonstrated inferior slippage of the lateral rectus pulley and other supporting tissues, along with medial displacement of the superior rectus. These anomalies cause a progressively worsening hypotropia and esotropia. The medial rectus is often tight, exacerbating the severity of the esotropia.
Various surgical procedures have been devised to overcome the defect by stabilizing the position of the lateral rectus muscle. An effective option is a joining of the superior and lateral rectus muscles, usually with a nonabsorbable suture, to reposition the globe. Recession of the medial rectus muscle may also be necessary if the muscle is tight.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.