Bilateral myopic strabismus fixus with fat prolapse treated by silicone band loop myopexy and excision of fat

Abstract

A 60-year-old man presented to our outpatient clinic with chief complaints of progressive inward deviation of both eyes and presence of a yellowish mass in both eyes for 2 years. On examination, the best-corrected visual acuity in the right eye (RE) was perception of light with accurate projection of rays and 20/126 in the left eye (LE). On ocular motility evaluation, there was limitation of abduction and elevation of -4 (figure 1A). The modified Krimsky test showed a large esotropia of about 110 prism diopters (PD) and 14 PD hypotropia in both eyes. A subconjunctival, yellow, soft, avascular, non-pulsatile, mobile mass was noticed supero-temporally in both eyes (figure 1B). While the palpebral part of the lacrimal gland was not visible, the orbital part could not be palpated. Examination of the anterior segment showed surgical aphakia in the RE and nuclear cataract in the LE. Fundus examination showed severe myopic tessellations in both eyes with normal optic discs, and there was a chorio-retinal atrophic patch involving the macula, suggestive of myopic maculopathy in the RE. The axial length was 34.21 and 34.41 mm in the RE and LE, respectively. CT scan of the orbit showed nasal shift of the superior rectus (SR) and inferiorisation of the lateral rectus (LR) with extraconal fat prolapse bilaterally (figure 1C).