Heavy Eye Syndrome
“Heavy eye syndrome,” also termed strabismus fixus, may result in progressive esotropia and hypotropia in patients with high myopia. The esotropia and hypotropia are associated with limited abduction and supraduction of the eye resulting from the superotemporal shift of the staphylomatous globe posteriorly, with medial displacement of the superior rectus muscle and inferior displacement of the lateral rectus muscle. The intervening connective tissue band also degenerates. Neuroimaging is necessary to confirm the muscle slippage. The preferred initial surgical approach for heavy eye syndrome is bilateral loop myopexy between the superior and lateral rectus muscles in order to restore the normal anatomic configuration, as opposed to medial rectus muscle recession or lateral rectus muscle resection, which can make the deviation worse.
Durnian JM, Maddula S, Marsh IB. Treatment of “heavy eye syndrome” using simple loop myopexy. J AAPOS. 2010;14(1):39–41.
Krzizok TH, Schroeder BU. Measurement of recti eye muscle paths by magnetic resonance imaging in highly myopic and normal subjects. Invest Ophthalmol Vis Sci. 1999;40(11): 2554–2560.
Ranka MP, Steele MA. Esotropia associated with high myopia. Curr Opin Ophthalmol. 2015; 26(5):362–365.
Tan RJ, Demer JL. Heavy eye syndrome versus sagging eye syndrome in high myopia. J AAPOS. 2015;19(6):500–506.
Excerpted from BCSC 2020-2021 series: Section 5 - Neuro-Ophthalmology. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.