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 Table of Contents    
LETTER TO EDITOR
Year : 2017  |  Volume : 10  |  Issue : 2  |  Page : 126-127  

Myopic strabismus fixus with endophthalmitis


Department of Ophthalmology, Military Teaching Hospital Med-V Rabat, Hay Riad, Rabat, Morocco

Date of Web Publication29-Jun-2017

Correspondence Address:
Taoufik Abdellaoui
Moukawama Avenue, N 13, Appt. 5, Rabat
Morocco
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ojo.OJO_109_2016

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How to cite this article:
Abdellaoui T, Abaloune Y, Messaoudi R, Elasri F, Reda K, Oubaaz A. Myopic strabismus fixus with endophthalmitis. Oman J Ophthalmol 2017;10:126-7

How to cite this URL:
Abdellaoui T, Abaloune Y, Messaoudi R, Elasri F, Reda K, Oubaaz A. Myopic strabismus fixus with endophthalmitis. Oman J Ophthalmol [serial online] 2017 [cited 2019 Dec 13];10:126-7. Available from: http://www.ojoonline.org/text.asp?2017/10/2/126/209103



Sir,

Convergent strabismus fixus is a rare ocular motor abnormality, in which the affected eye is more or less fixed in extreme adduction. Different causes of acquired convergent strabismus fixus have been reported such as intraocular tumor or amyloidosis. More frequently, convergent strabismus fixus is associated with high myopia. We hereby report a clinical case of bilateral myopic strabismus fixus with endophthalmitis of the right eye.

A 72-year-old woman with a history of high myopia, never corrected since childhood, was admitted for endophthalmitis complicating corneal abscess of the right eye. Furthermore, we noticed convergent strabismus [Figure 1]; no voluntary eye movement was possible. The patient reported that this progressive ocular deviation goes back to many years ago and that she never presented for it. Fundus examination of the left eye found large areas of chorioretinal atrophy [Figure 2]. Moreover heterogeneous vitreous of the right eye, magnetic resonance imaging (MRI) of the orbits demonstrated deviation and elongation of eyeballs, axial length measuring 33 mm [Figure 3], and inferomedial displacement of the lateral rectus muscle (LR) and nasal displacement of the superior rectus muscle in both eyes [Figure 4]. Evisceration of the right eye was performed given the worsening of the infection in despite antibiotics administrated locally (eye drops and intravitreal) and intravenous. Muscle biopsy during evisceration for histological analysis showed no myopathy. The patient refused surgery on his left eye strabismus.
Figure 1: Endophthalmitis of the right eye, and convergent strabismus of both eyes

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Figure 2: Left eye funduscopy: large areas of chorioretinal atrophy

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Figure 3: Magnetic resonance imaging: Ocular deviation and elongation, with heterogeneous vitreous in the right eye

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Figure 4: Inferomedial displacement of the lateral rectus muscle and nasal displacement of the superior rectus muscle in both eyes (arrows)

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In convergent strabismus fixus, the involved eye is fixed in a position of extreme adduction. Myopic strabismus fixus is classically seen in cases of high myopia (axial lengths >28 mm) characterized by a progressive esotropia and hypotropia associated with a limited elevation and abduction. Yokoyama et al. have explained this eso-hypodeviation in myopic strabismus as a consequence of shifting of the muscles secondary to elongation of the eyeball.[1] Krzizoh et al., based on MRI findings, postulated the downward displacement of the LR, reducing the abduction effect, and leading not only to an esotropia but also to a hypotropia, as major pathophysiological factor in myopic strabismus fixus.[2] In general, there are two main surgical techniques for myopic strabismus fixus, which have a different approach: (1) Conventional recession-resection surgery that mainly alters muscle forces and (2) innovative surgery procedures that allow to correct deviated muscle paths and get a normalized alignment of the muscle course by myopexy of the LR at the equator [3] or by transposition surgery.[4]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Yokoyama TT, Ataka S, Shiraki K, Miki T, Mochizuki K. The mechanism of development in progressive esotropia with high myopia. In: De Faber JT, editor. Transactions: 26th Meeting, European Strabismological Association, Barcelona, Spain, 2000. Lisse, Netherlands: Swets and Zeitlinger; 2000. p. 218-21.  Back to cited text no. 1
    
2.
Krzizoh TH, Kaufmann H, Traupe H. Elucidation of restrictive motility in high myopia by magnetic resonance imaging. Arch Ophthalmol 1997;115:1019-27.  Back to cited text no. 2
[PUBMED]    
3.
Wong I, Leo SW, Khoo BK. Loop myopexy for treatment of myopic strabismus fixus. J AAPOS 2005;9:589-91.  Back to cited text no. 3
[PUBMED]    
4.
Godeiro KD, Kirsch D, Tabuse MK, Cronemberger M. Yamada's surgery for treatment of myopic strabismus fixus. Int Ophthalmol 2009;29:305-8.  Back to cited text no. 4
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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