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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? 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? 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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normal New abnormal SR vector - elevates less well & adducts New abnormal LR vector & ANTI- ELEVATOR Normal SR vector
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Large Angle ET + High Myopia Heavy Eye Syndrome [not really heavy] Inferior displacement of lateral rectus i)Reduced abducting force of the lateral rectus ii)LR restricts elevation
![Large Angle ET + High Myopia Heavy Eye Syndrome [not really heavy] Inferior displacement of lateral rectus i)Reduced abducting force of the lateral rectus ii)LR restricts elevation](http://images.slideplayer.com/14/4467004/slides/slide_11.jpg "Large Angle ET + High Myopia Heavy Eye Syndrome [not really heavy] Inferior displacement of lateral rectus i)Reduced abducting force of the lateral rectus ii)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
![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](http://images.slideplayer.com/14/4467004/slides/slide_15.jpg "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
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