Myopic Strabismus Fixus (Heavy eye syndrome (HES)) as a cause of intermittent diplopia

Abstract

HES is a rare sequela of individuals who suffer from severe myopia which can result in a form of strabismus which classically presents as an intermittent horizontal diplopia. The term ‘heavy eye’ originates from a previous misconception that the symptomatology was a result of a ‘heavier’ globe which drooped anteriorly. It is now believed to be the result of superotemporal herniation of the posterior part of the globe through the lateral conal musculature which in turn causes dysfunction of the normal muscular pull of the superior and lateral recti of the orbit which in turn show medial and inferior deviation respectively as a consequence.