An atypical case of myopic strabismus fixus

We present an atypical case of progressive fixed hypertropia in a patient with extreme myopia. Myopic strabismus fixus is typically characterized by progressive esotropia and hypotropia, which is caused by the protrusion of the posterior eyeball from the superotemporal quadrant of the extraocular muscle cone. In this case, the patient's right eye was fixed in a superomedial position, and the left eye was fixed and deviated upward. Magnetic resonance imaging revealed protrusion of a posterior scleral staphyloma inferotemporally in each eye. This case illustrates how the pattern of strabismus fixus caused by high myopia depends on the direction of the protrusion of the posterior pole and the resulting displacement of extraocular muscle paths.