Purpose of review: The aim of the present article is to describe the pathophysiology of esotropia associated with high myopia, commonly known as heavy eye syndrome, and discuss the preoperative evaluation and surgical options in these complex patients.
Recent findings: Numerous studies have looked to determine the cause of esotropia in patients with high myopia. Orbital imaging has shown a nasal displacement of the superior rectus muscle and an inferior displacement of the lateral rectus muscle. As such, traditional resection-recession surgery can be ineffective in these patients. Instead, correcting the deviant muscles paths is necessary. Recent studies have shown that loop myopexy with or without medial rectus recession can be performed without sclera fixation sutures to correct the underlying pathophysiology.
Summary: Heavy eye syndrome or strabismus fixus is a rare restrictive strabismus. Careful preoperative evaluation must be performed in order to correctly diagnose these patients. If posterior globe prolapse with superior and lateral rectus muscle displacement is seen, loop myopexy can be a well tolerated and effective procedure in treating heavy eye syndrome.