Surgical treatment outcomes in heavy eye syndrome - a case series

ABSTRACT

Purpose: Heavy eye syndrome (HES) is characterized by a progressive, large angle esotropia and hypotropia, leading to limited abduction and supraduction of the affected eye. This study presents the effectiveness of a surgical intervention for heavy eye syndrome, an infrequent condition associated with high myopia. This investigation assesses the outcomes of a surgical technique involving an adaptation of the full loop myopexy technique originally proposed by Yokoyama et al.Methods: Conducted at Unidade Local de Saúde de Matosinhos, between 2017 and 2021, this retrospective study includes five patients diagnosed with HES. A dataset, comprising demographic information, clinical parameters, and detailed orthoptic evaluations, was documented for each patient. Both preoperative and postoperative assessments were conducted. MRI imaging was employed to visualize the orbits and confirm characteristic anatomical features associated with HES. The surgical procedure involved isolating and partially splitting the LR and SR muscles, with posterior fixation to the sclera at the equator of the globe, halfway between the two muscles, approximately 15 mm from their respective insertions. 5/0 ethibond sutures were applied. Retroequatorial myopexy was additionally performed in cases where the MR muscle exhibited significant abduction restriction.

Results: The study cohort comprised five patients, each presenting with unilateral high axial myopia and classic clinical features of HES, including large angle esotropia, hypotropia, and restricted abduction and supraduction. All patients displayed evident superotemporal globe prolapse on MRI imaging, corresponding to the downward displacement of the LR muscle and medial shift of the SR muscle.

Following the surgical procedure, all patients demonstrated significant improvements in both vertical and horizontal deviations, effectively addressing the primary clinical manifestations of HES.

Conclusions: In the management of HES, several surgical approaches have been explored, yielding mixed results. Our study, employing the technique of partial muscle splitting and scleral fixation, offers a promising avenue for effectively addressing this challenging condition. By adapting the full loop myopexy technique originally proposed by Yokoyama et al. we achieved satisfactory ocular alignment in all five patients. Notably, this approach mitigates the risk of anterior segment ischemia by preserving the unsecured portions of the SR and LR muscles along with MR retroequatorial myopexy.

These findings support the consideration of this surgical technique as a safe and effective option for managing HES, providing both cosmetic and functional improvements to afflicted individuals.

KEYWORDS:

• Heavy eye syndrome
• myopexy
• myopia

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The author(s) reported there is no funding associated with the work featured in this article.