Heavy Eye Syndrome

Question 1

HEAVY EYE SYNDOME

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

Aetiology HEAVY EYE SYNDOME

Answer 2

Orbital connective tissue degeneration

Myopic globe elongation causes the posterior globe to prolapse from the muscle cone

Inferior displacement of the horizontal rectus pulleys in elderly patients

MRI studies have shown thinning of the ligament band between the Lateral rectus and Superior rectus

Question 3

diff dx of heavy eye syndrome

Answer 3

Graves Orbitopathy
Myasthenia Gravis
Neurogenic Palsies
Age related Distance Esotropia

Question 4

mx for heavy eye syndrome

Answer 4

Initially Conservative with Prisms/Occlusion

Surgery is the best option but takes time

MR Recession +/- LR Resection may not be enough and won’t correct the Hypotropia

Yokoyama technique (union between total muscle bellies of sr and lr)

Yamada (Hemitransposition of sr and lr muscles with scleral disinsertion and reinsertion combined with MR recession

Silicone band Myopexy loop: (silicone band passed joining Lr and sr via scleral tunnel + tightened to bring 2 muscles together)

Partial Jensens (Lr and sr split, lateral half of sr + superior half of LR sutured together- risk of ASI minimised)