An unusual case of adult progressive esotropia caused by high myopia

In progressive esotropia associated with high myopia and axial elongation, eso-hypodeviation of the eyeball occurs due to ocular dislocation and often progresses to complete fixed esotropia in the terminal stage. We report a rare case of this condition in whom manual pushing of the eyeball temporarily moved the ocular dislocation back into the muscle cone. A normal eye position and ocular movement were obtained in subsequent strabismus surgery. To our knowledge, there has been no previous report of such a case. It is uncertain if medial rectus muscle recession should be performed simultaneously with combination of the muscle bellies of the superior and lateral rectus muscles in surgery for progressive esotropia caused by high myopia. We discuss this issue in the context of the current case.

The patient was a 60 year old woman with a chief complaint of severe eso-hypotropia of the left eye, for which requested treatment. Ophthalmologic findings include refractive indices of -5.15 D right eye and left eye -22.0 D respectively. The left eye position was severely eso-hypotropic and ocular movement was limited in all directions. However, the left eye became capable of abduction when the medial side of the eye was pushed manually by rubbing during attempted levoversion. During levoversion while the patient was pushing the eyeball, the dislocation was reduced on Computerized Tomography imaging. In surgery, left medial rectus muscle recession and combination of the muscle bellies of the left superior rectus muscle and the left lateral rectus muscle were performed. After surgery, the eye position was markedly corrected and the abduction limitation was improved.

We encountered a case of progressive esotropia caused by high myopia in which ocular dislocation could be temporarily reversed. In this disease, pushing of the eyeball (push test) can be used to determine whether dislocation ban be temporarily reversed. If this is possible, determination of the degree of abduction may be useful for selection of an appropriate surgical procedure.