Acquired Esotropia in a middle aged female myope NOSA 2004

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Acquired Esotropia in a middle aged female
myope NOSA 2004

• Mark Donaldson Lionel Kowal, Ocular Motility
  Clinic, RVEEH
• Jenni Sorraghan, Optometrist, Shepparton

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Case Report
51 yo WCF 6 y progressive esotropia and
hypotropia POHx - Left anisomyopic
amblyopia - no known neurological / orbital
disease

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Examination findings
VA. R 6/12 L HM Refr R
-0.50-1.00 x 175 L - 40 (ret) EOM 27 ? L
ET 12 ? L hypotropia Reduced Abduction
Elevation LE
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Pre-op Photos
Poor elevation
L ET hypo
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For neurologists only

• What now?

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Axial length L 35 mm Normal LLR No intracranial
path
Inf displacement LLR Nasal displacement LSR SR/LR
angle 135 deg
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For Ophthalmologists and neurologists

• What is this?

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Large Angle Esotropia with High Myopia Heavy
Eye Syndrome
Progressive enlargement of myopic globe after
orbital growth has finished Globe appears to
prolapse / herniate between superior and lateral
recti ?orbital septum weakest here Abnormal
LR/SR position ? abnormal function Result
Large angle esotropia with hypotropia
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From Yokoyama et al
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From Yokoyama et al
Normal SR vector
New abnormal SR vector - elevates less well
adducts
normal
New abnormal LR vector ANTI- ELEVATOR
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Large Angle ET High Myopia Heavy Eye
Syndromenot really heavy

• Inferior displacement of lateral rectus
• Reduced abducting force of the lateral rectus
• LR restricts elevation

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Surgical management
Yokoyama procedure Join LR SR 15mm behind
limbus with permanent suture Elevates the
LR Abducts the SR Makes their function more
normal
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Post operative photos

• BEFORE / AFTER PHOTOS STRAIGHT, BETTER ELEVATION

Pre operative
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Post operative photos
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Conclusions Large Angle Esotropia with High
Myopia (Heavy Eye Syndrome)
Unusual mechanism of acquired esotropia with
hypo in a uni- or bi- lateral myope acquired
change in orbital anatomy and muscle
mechanics Distinctive pathophysiology which
dictates a logical and usually effective
treatment
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Conclusions Large Angle Esotropia with High
Myopia (Heavy Eye Syndrome)
Thank you