Heavy eye syndrome or convergent strabismus fixus is an acquired strabismus typically seen in eyes with high myopia. We present a case, discuss the aetiology and management, and include a short video illustrating the surgical procedure undertaken.

A 47-year-old highly myopic woman with h/o bilateral cataract surgery and B/L scleral buckling for retinal detachments, had left esotropia and hypotropia measuring more than 40 prism dioptres base-out and 12 prism dioptres base up. MRI orbits showed bilateral asymmetrical medial deviation of ocular bulbs, more on left side. Also, there was degeneration of lateral rectus-superior rectus band with displacement of lateral rectus downwards.

She underwent Botox to bi-medial recti after which she could demonstrate potential for binocular single vision. A left un-augmented loop Myopexy procedure and recession of the left medial rectus was thereafter performed under general anaesthesia. After surgery, her eyes were binocularly aligned for near with minimal esotropia for distance.

This case suggests that patients with significant esotropia combined with high myopia should be suspected to have heavy eye syndrome. Orbital imaging should be undertaken to demonstrate the anatomical abnormality and muscle paths to confirm a definite diagnosis. Modified Loop Myopexy was found to be effective in this case of heavy eye syndrome