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Restrictive myopathy
Last reviewed: 07.07.2025
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From 30 to 50% of patients with endocrine ophthalmopathy suffer from ophthalmoplegia, which can be permanent. Limitation of eye mobility is initially associated with inflammatory edema and later - fibrosis. Intraocular pressure can increase when looking up due to compression by the fibrously altered inferior rectus muscle. Sometimes the increase in intraocular pressure is persistent due to the combined effect of fibrously altered extraocular muscles and increased intraorbital pressure.
There are 4 types of movement disorders (in order of decreasing frequency).
- Limitation of upward mobility due to contracture of the fibrous inferior rectus muscle, which can be mistaken for paresis of the superior rectus muscle.
- Abduction disorder that can simulate a sixth cranial nerve palsy.
- Limitation of downward mobility due to fibrosis of the superior rectus muscle.
- Impaired adduction due to fibrosis of the lateral rectus muscle.
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Treatment of restrictive myopathy
- Surgical
- Indications: diplopia with normal gaze direction or when reading, with stabilization of the condition and stable angle of strabismus for at least 6 months. Until then, the deviation can be alleviated by using prisms;
- goal: to achieve binocular vision in normal gaze direction and when reading. Restrictive myopathy, leading to strabismus, often makes binocular vision impossible in any position. However, over time, the binocular vision zone may expand as a result of increased vergence;
- The inferior rectus and/or medial rectus recession technique is best performed using adjustable sutures (which is what is most commonly done). The sutures are adjusted on the first postoperative day until the optimal position is achieved, and the patient is encouraged to develop binocular vision by looking at a distant object, such as a television screen, with both eyes.
- Injection of CI botulinum toxin into the affected muscle is effective in some cases.