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Case report

Nasal loop myopexy for management of exotropia-hypotropia complex associated with high myopia

, &
Published online: 08 Jul 2024
 

ABSTRACT

Introduction

Exotropia-hypotropia complex is an uncommon phenomenon associated with high myopia. However, some literature reports cases of the exotropia-hypotropia complex where residual hypotropia is managed through a secondary surgery following the conventional recession-resection of the lateral rectus (LR) and medial rectus (MR). Nasal Loop myopexy as a primary surgical procedure for the management of exotropia-hypotropia complex has been rarely reported in the literature.

Methods

A 24-year-old male with unilateral high myopia presented with a large angle exotropia-hypotropia complex with limitation of elevation in abduction in his left eye. His ocular deviation was successfully managed through a nasal loop myopexy of the superior rectus (SR) and MR using a non-absorbable suture, combined with large LR recession and MR resection.

Results

Postoperatively, the patient had satisfactory ocular alignment with improved hypotropia and normal elevation in abduction, contributing to enhanced binocular vision and better cosmesis.

Discussion

Managing the exotropia-hypotropia complex in the context of high myopia demands a comprehensive approach that addresses both vertical and horizontal deviations. The surgical strategy employed in this case, which included loop myopexy of SR and MR along with LR recession and MR resection, achieved positive outcomes regarding alignment, elevation, and binocular vision. The case supports variations in muscle path and the potential benefits of tailored surgical strategies for complex strabismus cases associated with high myopia.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Dr. Neelam Pawar is currently a Research Scholar at Kellogg Eye Centre, University of Michigan, Ann Arbor, MI, USA supported by a grant from NIH/Fogarty International Centre [D43TW012027].

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