I read an interesting case of a woman with high myopia (16 diopters) who presented with progressive esotropia and hypotropia OS over a three year period. It was pretty constant in all fields of gaze. Restriction was noted on forced ductions. MRI showed inferiorly displaced lateral rectus and medially displaced superior rectus. A diagnosis of strabismum fixus secondary to high myopia was made- don’t see that too often. It would seem the globe is just too big and it forces these muscles to be displaced. They got a good repair just by suturing those two muscles together.