HEAVY EYE SYNDOME / ESOTROPIA ACQUIRED WITH MYOPIA

Question 1

Heavy eye syndrome

Answer 1

Heavy eye syndrome is an important type of myopia-induced strabismus.
Heavy eye syndrome presents with a progressive, usually large-angle esotropia and hypotropia causing limited abduction and supraduction, respectively. This condition is an acquired, progressive strabismus typically seen in eyes with increased axial lengths and high myopia, typically more than 25 D. Case reports of convergent strabismus fixus in the absence of high myopia and strabismus fixus in the setting of exotropia have been described; however, these cases are rare and more controversial.

Question 2

Characteristics of constant esotropia acquired with myopia?
(mod and high)

Answer 2

Moderate degree (-6 to -12DS)
Gradual onset & present in young adults
ET > for dist
Signs: c/o diplopia
Require prism/surgical Mx
High Degree (>-15DS)
Very gradual onset
More commonly present in older pateints
Associated progressive myopia
Signs
Rarely complain of diplopia
Restricted OM

Question 3

Investigation of SOT acquired with myopia?

Answer 3

-Duction Eye movements?
Moderate or severe restriction = CT or MRI (can be significant pulley displacement = post equatorial muscle union) (if no significant muscle pulley displacement then conventional surgery)
If full or only mild restriction = conventional surgery

Question 4

Management of SOT acquired with myopia?

Answer 4

Nonsurgical
Prisms – CL wear restricts use
Botulinum Toxin A to MR

Surgical
MR recession / LR resection
Larger recession
Superior transposition if hypotropia