Heavy eye syndrome in a paediatric patient: an unusual presentation of highly myopic restrictive strabismus.

Heavy eye syndrome is an acquired restrictive strabismus typically observed in adult patients with high axial myopia. We report an unusual paediatric case of a teenage girl with progressive myopia and a large-angle esotropia. Coronal orbital MRI confirmed the diagnosis by showing inferior slippage of the lateral recti and nasal slippage of the superior recti. Management involved a two-stage surgical approach: a bilateral Yokoyama procedure followed by bilateral medial rectus recession. This strategy achieved a successful correction of the ocular alignment and significant improvement in ocular motility, along with the restoration of simultaneous perception.