Strabismus and myopia: a challenge for the ophthalmologist

Myopia is a condition widely spread throughout the world, and it is expected to affect almost half of the population within 2050. Its correlation with many ocular pathologies, such as retinal detachment, retinal degeneration, maculopathy, glaucoma and cataract, is already well known. Strabismus associated with myopia is more likely to develop as exotropia; however it can also show different clinical features, and thus therapeutic needs, which often make it a challenge for the ophthalmologist to be detected and treated. Heavy eye syndrome is a pathology related to high degenerative myopia, and it is characterized by a wide range of deviation, which goes from a small angle esotropia to a large angle of eso-hypodeviation. Bielschowsky esotropia, ore AACE type III esotropia, is a condition spreading rapidly among population, mainly in association with the use of electronic devices. It is characterized by onset of diplopia for distance vision, followed by the involvement of near vision, and for the preservation of binocular vision. Treatment options include prisms and botulinum toxin therapy; however surgery remains the best curative alternative. Myopia is a predisposing factor for rhegmatogenous retinal detachment, which often can be treated with the positioning of scleral buckling. This surgery is related to the development of strabismus, due to the extraocular motility restriction and subsequent diplopia. Finally, refractive surgery for the treatment of myopia may result in different type of strabismus and diplopia, through many different mechanisms. This review aims to describe clinical features and therapeutic approaches for all these conditions.