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Management of esotropia: hypotropia in neurofibromatosis type 1 – simulating myopic strabismus fixus
  1. Mayank Jain and
  2. Ramesh Kekunnaya
  1. Jasti V Ramanamma Children's Eye Care Center, Child Sight Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
  1. Correspondence to Dr Ramesh Kekunnaya; drrk123{at}


A 28-year-old man presented with a progressive inward deviation of the left eye in the last 4 years. Examination revealed −3 abduction and elevation deficit in the left eye with 50 prism diopters (PD) esotropia and 12 PD of hypotropia. The patient had multiple fibromas on the forearms with pulsatile globe and was diagnosed as neurofibromatosis type 1. Myopic strabismus fixus was suspected. MRI revealed left temporal lobe herniation through a dysplastic sphenoid wing, compressing the posterior half of the superior rectus and lateral rectus muscles, resulting in an esotropia-hypotropia complex. Surgical treatment involved suture myopexy (Yokoyama’s technique) of the left superior rectus and lateral rectus muscles with a 6.5 mm left medial rectus recession. Two months postoperatively, the patient had minimal residual esotropia and hypotropia. MRI orbits should always be performed in high myopes with strabismus to assess extraocular muscle pathways.

  • ophthalmology
  • neuroopthalmology
  • neurosurgery
  • dermatology
  • orthopaedics

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  • Contributors RK took care of the patient from preoperative workup to postoperative care. The patient was operated under the care of RK. MJ designed the concept for case report. MJ was involved in collection of data, drafting the manuscript of the case report and ensuring all patient details and images to be collected along with proper consent from the patients. RK and MJ revised the manuscript and maintained the standards of the manuscript as per BMJ protocols. The final manuscript was approved by both authors, that is, RK and MJ. All authors are responsible for the integrity and accuracy of the data provided.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.