{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T12:14:18Z","timestamp":1788178458286,"version":"build-2803163510"},"reference-count":7,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,8,20]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2026-275803","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T11:20:20Z","timestamp":1788175220000},"page":"e275803","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Heavy eye syndrome in a paediatric patient: an unusual presentation of highly myopic restrictive strabismus"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6599-7700","authenticated-orcid":false,"given":"Giuseppe","family":"Rao","sequence":"first","affiliation":[{"name":"Department of Surgical Science, Division of Ophtalmology, IRCCS Istituto Giannina Gaslini, Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Cuccurnia","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ophtalmology Unit, ASL 1 Imperiese, Imperia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Laviosa","sequence":"additional","affiliation":[{"name":"Ophtalmology Unit, ASUIT Trento, Santa Chiara Hospital, Trento, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Massa","sequence":"additional","affiliation":[{"name":"Department of Surgical Science, Division of Ophtalmology, IRCCS Istituto Giannina Gaslini, Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rossana Gilda","family":"Del Re","sequence":"additional","affiliation":[{"name":"Department of Surgical Science, Division of Ophtalmology, IRCCS Istituto Giannina Gaslini, Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrica","family":"Spaletra","sequence":"additional","affiliation":[{"name":"Department of Surgical Science, Division of Ophtalmology, IRCCS Istituto Giannina Gaslini, Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Tassara","sequence":"additional","affiliation":[{"name":"Department of Surgical Science, Division of Ophtalmology, IRCCS Istituto Giannina Gaslini, Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliano","family":"Serafino","sequence":"additional","affiliation":[{"name":"Department of Surgical Science, Division of Ophtalmology, IRCCS Istituto Giannina Gaslini, Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"2026083104201076000_19.8.e275803.1","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1080\/2576117X.2022.2037400","article-title":"Acquired Diplopia in Adults: Heavy Eye Syndrome","volume":"72","author":"Pineles","year":"2022","journal-title":"J Binocul Vis Ocul Motil"},{"key":"2026083104201076000_19.8.e275803.2","doi-asserted-by":"publisher","DOI":"10.1007\/s00417-020-04629-4"},{"key":"2026083104201076000_19.8.e275803.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaapos.2015.08.012"},{"key":"2026083104201076000_19.8.e275803.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2009.08.035"},{"key":"2026083104201076000_19.8.e275803.5","doi-asserted-by":"crossref","first-page":"e1340","DOI":"10.1111\/aos.14808","article-title":"Yokoyama procedure for esotropia associated with high myopia: real-world data from a large-scale multicentre analysis","volume":"99","author":"Wabbels","year":"2021","journal-title":"Acta Ophthalmol"},{"key":"2026083104201076000_19.8.e275803.6","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.ophtha.2023.12.040","article-title":"Adult Strabismus Preferred Practice Pattern\u00ae","volume":"131","author":"Dagi","year":"2024","journal-title":"Ophthalmology"},{"key":"2026083104201076000_19.8.e275803.7","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2014-305166"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-275803","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T11:20:21Z","timestamp":1788175221000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-275803"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":7,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,31]]},"published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1136\/bcr-2026-275803"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-275803","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]}}}