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Strabismus fixus convergens secondary to protracted hydrocephalus
Asmita Mahajan1, Swati Phuljhele2
1Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India asmitamahajn@gmail.com.
BMJ Case Reports
|August 25, 2025
Summary
This study details a rare case of strabismus fixus in a male patient, resulting from brain tumor complications. Surgical intervention successfully restored near-normal eye alignment.
Area of Science:
- Ophthalmology
- Neurology
- Neuro-oncology
Background:
- A rare case of strabismus fixus is presented in a middle-aged male with a 12-year history of hypotropia-esotropia.
- The patient had a prior diagnosis and surgery for a posterior fossa pilocytic astrocytoma.
Purpose of the Study:
- To describe a unique presentation of strabismus fixus.
- To investigate the underlying causes of the patient's ocular misalignment.
- To report the surgical management and outcome.
Main Methods:
- Contrast-enhanced MRI of the brain and orbit was performed.
- Clinical examination assessed ocular alignment and motility.
- Surgical correction involved bilateral medial rectus recession and inferior rectus recession.
Main Results:
- MRI revealed dilated ventricles, a shunt, and distorted midbrain architecture.
- No displacement of recti or axial elongation was observed.
- Surgical treatment achieved near orthotropia.
Conclusions:
- The patient's strabismus fixus was likely caused by damage to vertical gaze centers and sixth nerve palsy due to hydrocephalus.
- This represents a novel case of strabismus fixus resulting from coexisting upgaze palsy and sixth nerve palsy.
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