Home Page Strabismus Course Strabismus Books Strabismus Videos

Strabismus Lectures Case of the week E Consultation Contact me



Case of the week 41 ( March 2012 )
 The Heavy Eye Syndrome



This 42 year old man was referred by one of my closed colleagues asking the advice about his eye deviation .
I'm using his referral letter :

Dear Gamal ,
" This patient is myopic anisometropic in the order of -6 Rt. eye and - 28 Lt. eye . I'm preparing him for Rt. lasik and left ICL or clear lens extraction - as a second choice- this Lt. eye is corrected to 6/24 with trial lenses- what about this Lt. esotropia ?? "
                                        much obliged

 Examination of the patient showed the left eye is esotropic 15 PD & hypotropic 8 PD


THE HEAVY EYE SYNDROME

          
   


THE HEAVY EYE SYNDROME

Heavy eye syndrome is an association of anisometropia with high myopia.This syndrome consists of a slow and progressive development of esotropia and hypotropia.

Pathogenesis

The Highly myopic eye (>−20.00) with severe axial length elongation  causes an esotropia, and hypotropia, with limited abduction and elevation . Superior temporal expansion of the globe displaces the lateral rectus muscle inferiorly and the superior rectus muscle nasally. This muscle displacement changes the vector of forces of the muscles. The lateral rectus muscle loses its abduction function and becomes a depressor, while the superior rectus muscle changes from an elevator to an adductor.

It was postulated that scleral ectasia in these patients causes a downslip of the muscle in relation to the globe. This change of muscle path gives the muscle a depressing effect at the cost of its physiologic action of abduction.

In the usual clinical situation, the vertical deviation ranges from 2 to 25D,although there is no association between the amount of anisometropia and the amount of hypotropia. Elevation of the low eye may be limited. Frequently, the head tilts to the side of the hypotropic eye, which may be compensatory to achieve single vision .

Therapy

The treatment of the heavy eye syndrome (esotropia and hypotropia) is to move the displaced muscles back to their appropriate location. The lateral rectus muscle is transposed superiorly, and the superior rectus muscle temporally and united at the equator with a non-absorbable suture like a Jensen transposition . The suture is passed 14 mm posterior to the insertion, and through one half width of each muscle as described by Yokoyama. In addition, perform a medial rectus recession, as the medial rectus will be tight.

To normalize the lateral Rectus abnormal low path  many  recommend adding a supratransposition to a resection of the lateral rectus in combination with a recession of the medial rectus muscle. This what I have done to this patient . Both me and him are satisfied with the result .

الموقع المصري للحول وامراض الجهاز الحركي للعين

The Egyptian Site of Strabismus & Oculomotor Disorders