Ocular Motility Abnormalities



Highly myopic strabismus is a rare acquired ocular motility disorder that affects highly myopic adults. The axial length of the eye frequently exceeds 30 mm. The eye movement is mechanically restricted in both abduction and supraduction, resulting in esotropia and hypotropia. In the most advanced form, strabismus fixus, the affected eye is so tightly fixed in an esotropic and hypotropic position that no movement in any other direction is possible even passively. MRI reveals that the globe is dislocated out from the muscle cone through the space between the superior and lateral rectus muscles. A surgical procedure to unite the muscle bellies of the superior and lateral rectus muscles is effective on improving both abnormal ocular motility and eye position.

The influence of myopia on concomitant strabismus is also briefly discussed.


Rectus Muscle Lateral Rectus Medial Rectus Union Surgery Superior Rectus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Mansour AM, Wang F, el-Baba F, Henkind P. Ocular complications in strabismus fixus convergens. Ophthalmologica. 1987;195:161–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Kaynak S, Durak I, Ozaksoy D, Canda T. Restrictive myopic myopathy: computed tomography, magnetic resonance imaging, echography, and histological findings. Br J Ophthalmol. 1994;78:414–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Bagolini B, Tamburrelli C, Dickmann A, Colosimo C. Convergent strabismus fixus in high myopic patients. Doc Ophthalmol. 1990;74:309–20.PubMedCrossRefGoogle Scholar
  4. 4.
    Kowal L, Troski M, Gilford E. MRI in the heavy eye phenomenon. Aust N Z J Ophthalmol. 1994;22:125–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Taylor R, Whale K, Raines M. The heavy eye phenomenon: orthoptic and ophthalmic characteristics. Ger J Ophthalmol. 1995;4:252–5.PubMedGoogle Scholar
  6. 6.
    Sturm V, Menke MN, Chaloupka K, Landau K. Surgical treatment of myopic strabismus fixus: a graded approach. Graefes Arch Clin Exp Ophthalmol. 2008;246:1323–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Hayashi T, Iwashige H, Maruo T. Clinical features and surgery for acquired progressive esotropia associated with severe myopia. Acta Ophthalmol Scand. 1999;77:66–71.PubMedCrossRefGoogle Scholar
  8. 8.
    Krzizok TH, Kaufmann H, Traupe H. Elucidation of restrictive motility in high myopia by magnetic resonance imaging. Arch Ophthalmol. 1997;115:1019–27.CrossRefGoogle Scholar
  9. 9.
    Yamaguchi M, Yokoyama T, Shiraki K. Surgical procedure for correcting globe dislocation in highly myopic strabismus. Am J Ophthalmol. 2010;149:341–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Hugonnier R, Magnard P. Oculomotor disequilibrium observed in cases of severe myopia. Ann Ocul (Paris). 1969;202:713–24.Google Scholar
  11. 11.
    Duke-Elder S, Wybar KC. Strabismus fixus. In: Duke-Elder S, editor. System of ophthalmology, vol. 6. London: Henry Kimpton; 1973. p. 607–8.Google Scholar
  12. 12.
    Demer JL, von Noorden GK. High myopia as an unusual cause of restrictive motility disturbance. Surv Ophthalmol. 1989;33:281–4.PubMedCrossRefGoogle Scholar
  13. 13.
    Aydin P, Kansu T, Sanac AS. High myopia causing bilateral abduction deficiency. J Clin Neuroophthalmol. 1992;12:163–5; discussion 166.PubMedGoogle Scholar
  14. 14.
    Ohta M, Iwashige H, Hayash T, Maruo T. Computed tomography findings in convergent strabismus fixus. Nippon Ganka Gakkai Zasshi Soc. 1995;99:980–5.Google Scholar
  15. 15.
    Herzau V, Ioannakis K. Pathogenesis of eso- and hypotropia in high myopia. Klin Monatsbl Augenheilkd. 1996;208:33–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Krzizok TH, Schroeder BU. Measurement of recti eye muscle paths by magnetic resonance imaging in highly myopic and normal subjects. Invest Ophthalmol Vis Sci. 1999;40:2554–60.PubMedGoogle Scholar
  17. 17.
    Yokoyama T, Tabuchi H, Ataka S, Shiraki K, Miki T, Mochizuki K. The mechanism of development in progressive esotropia with high myopia. In: de Faber JTHN, editor. Transactions of the 26th meeting, European Strabismological Association, Barcelona, Spain, September 2000. Lisse: Swets & Zeitlinger Publishers; 2001. p. 218–21.Google Scholar
  18. 18.
    Yokoyama T, Ataka S, Tabuchi H, Shiraki K, Miki T. Treatment of progressive esotropia caused by high myopia – a new surgical procedure based on its pathogenesis. In: de Faber JTHN, editor. Transactions of the 27th meeting, European Strabismological Association, Florence, Italy, June 2001. Lisse: Swets & Zeitlinger Publishers; 2002. p. 145–8.Google Scholar
  19. 19.
    Krzizok TH, Kaufmann H, Traupe H. New approach in strabismus surgery in high myopia. Br J Ophthalmol. 1997;81:625–30.PubMedCrossRefGoogle Scholar
  20. 20.
    Ohba M, Kawata H, Ohguro H, Fukushi N. An unusual case of adult progressive esotropia caused by high myopia. Binocular Vis Strabismus Q. 2008;23:31–5.Google Scholar
  21. 21.
    Sidikaro Y, von Noorden GK. Observations in sensory heterotropia. J Pediatr Ophthalmol Strabismus. 1982;19:12–9.PubMedGoogle Scholar
  22. 22.
    von Noorden GK, Campos EC. Binocular vision and ocular motility. Theory and management of strabismus. 6th ed. St. Louis: Mosby; 2002.Google Scholar
  23. 23.
    Curtin BJ. Motility. In: The myopias. Basic science and clinical management. Philadelphia: Harper & Row; 1985. p. 292–7.Google Scholar
  24. 24.
    Shimojyo H, Kitaguchi Y, Asonuma S, Matsushita K, Fujikado T. Age-related changes of phoria myopia in patients with intermittent exotropia. Jpn J Ophthalmol. 2009;53:12–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Ekdawi NS, Nusz KJ, Diehl NN, Mohney BG. The development of myopia among children with intermittent exotropia. Am J Ophthalmol. 2010;149:503–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Damms T, Damms C, Schulz E, Haase W. Pseudo-esotropia caused by nasal dislocation of the macula in patients with high infantile myopia. Ophthalmologe. 1994;91:77–80.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of Pediatric OphthamologyOsaka City General Hospital Children’s Medical CenterOsakaJapan

Personalised recommendations