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CORRESPONDING AUTHOR Katarzyna Pelińska, Department of Binocular Vision Pathophysiology, First Chair of Ophthalmology, Medical University of Lodz, 22 Kopcińskiego St., 90-153 Lodz, Poland, e-mail: katarzynapelinska@gmail.com INTRODUCTION Myopic strabismus fixus (MSF) is a consequence of very high myopia, also called heavy eye syndrome (HES), which is characterized by esotropia and hypotropia [1]. It usually occurs in elderly patients and is progressive in nature. The severity of strabismus is related to the axial length of the eye. A great number of patients tend to have myopia larger than 15 D and the axial length longer than 30 mm [2]. The growing eye has very weak orbital septa especially between the superior rectus muscle (SR) and medial rectus muscle and between the lateral rectus muscle (LR) and inferior rectus muscle. This is the reason why the lateral rectus is displaced inferiorly and the superior rectus translocates nasally [1]. The disease is usually bilateral but can be asymmetric. Limitation of abduction of the eye induces diplopia and head turn. Subsequently patients start to use their better eye. It is rather rare to see a patient with such severe duction limitation that their visual functioning is impaired. Usually the problem is managed at an early or intermediate stage. A number of procedures have been proposed for HES including hemitransposition of rectus muscle [3], partial Jensen’s operation [4] and loop myopexy [5, 6], initially described by Yokoyama. The effectiveness of this procedure is related to the fact that it addresses the true cause of the problem, which is the displacement of superior and lateral rectus muscles [7].

Bilateral Yokoyama procedure in a patient with esotropic strabismus fixus due to severe myopia