Convergent strabismus fixus without high myopia

A 37-year-old woman presented with progressive large-angle esotropia (>140(Δ)) since childhood. Her best-corrected visual acuity was 20/80 in right eye and unrecordable in the left eye because of severe esotropia and limitation of abduction. Computed tomography of the orbits showed presence of nasal displacement of the superior rectus muscle and inferior displacement of the lateral rectus muscle in the left eye, which was confirmed intraoperatively. Intraoperatively, axial length was 23 mm in the right eye and 24.6 mm in the left eye. Diagnosed with convergent strabismus fixus without high myopia, she underwent medial rectus recession of 8.0 mm and superior rectus-lateral rectus loop myopexy. Postoperatively, she had an exotropia of about 8(Δ). This case highlights the possibility of progressive esotropia similar to "heavy eye syndrome" in the absence of high myopia.