Session: Free papers Session V - Esotropia 2

Retrospective review of features, investigation and management of acquired esotropia associated with high myopia (heavy eye syndrome) at Moorfields Eye Hospital

Introduction | The prevalence of myopia is increasing globally, most dramatically in Urban Asian populations but also across Western Europe. Acquired esotropia in high myopia, often termed ‘heavy eye syndrome’, generally develops in adulthood. There are no diagnostic criteria but MRI measurements of extraocular muscle paths and posterior eyeball prolapse can provide quantifiable evidence. MRI studies have shown inferior shift of lateral rectus (LR) and nasal shift of superior rectus (SR). The muscle union procedure, developed by Yokoyama in 2013, has been widely accepted as a primary procedure. 

 

Methods | We performed a retrospective review of adults (³18 years old) seen at our institution with a diagnosis of high myopia (spherical equivalent ³-6D) and strabismus. We use free text search functions on our electronic medical records (initiated 2018) to identify patients. We were keen to focus on MRI findings and therefore excluded those without neuroimaging. Presenting features including full orthoptic assessment, spherical equivalent, and associated myopic features were noted. In those who underwent surgery, the surgical technique chosen, and outcome was examined.

 

Results | We identified 69 adults with high myopia and associated strabismus, in all cases a predominant esotropia, attending Moorfields between 2018 and 2023. The mean age at initial assessment was 50 years (SD 18.1) with a minimum age of 18 years and maximum age of 89 years. We will describe presenting features, MRI findings (including where possible calculation of the angle formed by the globe, LR & SR = ‘angle of dislocation of the globe’), surgical approach and outcome.

 

Conclusions | The number of patients presenting with acquired esotropia as a result of high myopia may become an increasing burden. Classical features, the benefits of MRI assessment, and surgical approach will be discussed.