{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T20:38:05Z","timestamp":1781123885662,"version":"3.54.1"},"reference-count":15,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,11,21]]},"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:p>A 28-year-old man presented with a progressive inward deviation of the left eye in the last 4\u2009years. Examination revealed \u22123 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\u2019s technique) of the left superior rectus and lateral rectus muscles with a 6.5\u2009mm 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.<\/jats:p>","DOI":"10.1136\/bcr-2020-236648","type":"journal-article","created":{"date-parts":[[2023,3,14]],"date-time":"2023-03-14T00:12:03Z","timestamp":1678752723000},"page":"e236648","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Management of esotropia: hypotropia in neurofibromatosis type 1 \u2013 simulating myopic strabismus fixus"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8314-4725","authenticated-orcid":false,"given":"Mayank","family":"Jain","sequence":"first","affiliation":[{"name":"Jasti V Ramanamma Children's Eye Care Center, Child Sight Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramesh","family":"Kekunnaya","sequence":"additional","affiliation":[{"name":"Jasti V Ramanamma Children's Eye Care Center, Child Sight Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,12,17]]},"reference":[{"key":"2025082704100556000_13.12.e236648.1","doi-asserted-by":"crossref","first-page":"518E","DOI":"10.1097\/PRS.0000000000004779","article-title":"Sphenoid dysplasia in neurofibromatosis: patterns of presentation and outcomes of treatment","volume":"142","author":"Naran","year":"2018","journal-title":"Plast Reconstr Surg"},{"key":"2025082704100556000_13.12.e236648.2","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1016\/j.jaapos.2015.06.003","article-title":"Strabismus in patients with neurofibromatosis type 1-associated optic pathway glioma","volume":"19","author":"Parness-Yossifon","year":"2015","journal-title":"J Aapos"},{"key":"2025082704100556000_13.12.e236648.3","doi-asserted-by":"crossref","first-page":"19","DOI":"10.3928\/01913913-20180925-02","article-title":"Prevalence of strabismus among children with neurofibromatosis type 1 disease with and without optic pathway glioma","volume":"56","author":"Dotan","year":"2019","journal-title":"J Pediatr Ophthalmol Strabismus"},{"key":"2025082704100556000_13.12.e236648.4","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1016\/j.jaapos.2014.02.018","article-title":"Ocular motility abnormalities in orbitofacial neurofibromatosis type 1","volume":"18","author":"Oystreck","year":"2014","journal-title":"J Aapos"},{"key":"2025082704100556000_13.12.e236648.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9394(03)00276-9"},{"key":"2025082704100556000_13.12.e236648.6","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.70.1.26"},{"key":"2025082704100556000_13.12.e236648.7","first-page":"1043","article-title":"A case of neurofibromatosis type 1 with strabismus fixus, high myopia and cataract","volume":"58","author":"Matsuura","year":"2004","journal-title":"Japanese J Clin Ophthalmol"},{"key":"2025082704100556000_13.12.e236648.8","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.81.8.625"},{"key":"2025082704100556000_13.12.e236648.9","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2014-305166"},{"key":"2025082704100556000_13.12.e236648.10","doi-asserted-by":"crossref","DOI":"10.1155\/2015\/470473","article-title":"SR and LR Union suture for the treatment of myopic strabismus fixus: is scleral fixation necessary?","volume":"2015","author":"Lam","year":"2015","journal-title":"Biomed Res Int"},{"key":"2025082704100556000_13.12.e236648.11","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1016\/j.clineuro.2010.07.007","article-title":"Reconstruction of skull base defects in sphenoid wing dysplasia associated with neurofibromatosis I with titanium mesh","volume":"112","author":"Lotfy","year":"2010","journal-title":"Clin Neurol Neurosurg"},{"key":"2025082704100556000_13.12.e236648.12","first-page":"287","volume-title":"Reconstruction of the sphenoid wing in a case of neurofibromatosis type 1 and complex unilateral orbital dysplasia with pulsating exophthalmos. 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