Clinical and anatomical differences for heavy eye syndrome, highly myopic sagging eye syndrome, and sagging eye syndrome
Reviewed by Fiona Rowe

The authors explored the mechanisms underlying the development of heavy eye syndrome (HES), highly myopic sagging eye syndrome (SES)-like, and SES with the aim to differentiate the three conditions clinically and anatomically to aid treatment decision-making. This was a retrospective study including five patients (nine eyes) with strabismic highly myopic eyes with progressive esotropia and hypotropia, nine patients (eight eyes) with high myopia and highly myopic SES, and 22 patients (44 eyes) with SES. Mean age was 69.2 ±10.3, 69.1 ±7.8 and 73.8 ±9.6 years, mean axial length was 29.6 ±1.0, 29.0 ±1.5 and 23.7 ±0.9mm, mean distance esotropia was 48.0 ±19.9, 4.6 ±1.5 and 6.1 ±4.6PD, and mean lateral rectus / superior rectus displacement angle was 152.3 ±16.7, 125.0 ±7.1 and 112.5 ±7.5 degrees, respectively, for the three conditions. Mean distance hypotropia was 5.3 ±5.9PD for myopic SES and 4.8 ±2.7PD for SES. Lateral / superior rectus displacement angle was significantly different across groups. On MR imaging, all patients with HES had severe superotemporal globe prolapse. This was not seen in myopic SES. All cases of HES and six of 18 eyes with myopic SES had posterior staphyloma. The authors conclude myopic SES shows similar characteristics to SES such as lateral rectus displacement. However, the globe is more dislocated in SES which may influence management decisions.

Magnetic resonance imaging findings of high myopic strabismus with sagging eye-like symptoms, heavy eye syndrome and non-highly myopic eyes with sagging eye syndrome.
Tamura K, Kimoto K, Kubota T.
STRABISMUS
2024;32(1):48–53.