Heavy Eye Syndrome/Adult Onset Esotropia Secondary to High Axial Myopia
A patient with history of amblyopia right eye, and no previous ocular surgery or childhood strabismus presents with large angle esotropia and hypotropia. Exam was notable for hand movements vision in the right eye and 20/20 in the left eye. On slit lamp examination, the patient had bilateral pterygia, a dense white cataract of the right eye with no view to the fundus and a normal fundus examination of the left eye. Ocular motility showed a right eye esotropia of more than 100 prism diopters in primary position, a right eye hypotropia of 30 prism diopters and marked limitation to abduction and supraduction. MRI imaging showed a long anteroposterior length of the right eye along with dislocation of the superotemporal orbit with increased angle of dislocation between the superior rectus and lateral rectus. B Scan ultrasound showed an axial length of 34mm in the right eye and 25 mm in the left eye. The patient underwent a loop myopexy of the right eye with ipsilateral lateral rectus plication and ipsilateral medical rectus recession on adjustable suture. At the two-month post operative appointment, there was residual esotropia of 8 prism diopters for distance and 20 prism diopters for near, with marked improvement in abduction and supraduction.
Presentation Date: 03/09/2023
Issue Date: 03/24/2023
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