The heavy eye syndrome (HES) is an uncommon cause of strabismus in the elderly.

Synonym: myopic strabismus fixus


Pathogenesis: The condition is due to degeneration of the band between the superior recuts and lateral rectus muscle. The connective tissue band connecting the superior rectus and lateral rectus muscles originates from the lateral border of the superior rectus pulley and it terminates in the superior border of the lateral rectus pulley.


Degeneration of the band allows inferior displacement of the lateral rectus pulley and muscle.


Clinical features of HES:

(1) the patient is elderly

(2) most patients have high myopia

(3) the patient shows esotropia and limited abduction


Differentiation from the sagging eye syndrome can be achieved with MRI, which shows degeneration of the lateral recuts-superior rectus band.


The surgical correction for HES involves creation of connection between the superior rectus and lateral rectus muscles.

To read more or access our algorithms and calculators, please log in or register.