Surgical management of hypotropia and exotropia in high myopia: a case report

Myopic strabismus, also known as heavy eye syndrome, is a rare ocular motility disorder, typically presenting with bilateral esotropia and hypotropia. We present the case of a 42-year-old man who presented with progressive hypotropia and exotropia rather than esotropia. Orbital imaging revealed a superonasal staphyloma with pathological changes in the extraocular muscles. Surgical correction involved loop myopexy between the superior rectus and medial rectus muscles combined with lateral rectus recession.