Sagging eye syndrome presenting as a form of strabismus fixus

Lateral rectus–superior rectus band degeneration with aging is the major cause of sagging eye syndrome, which usually presents with small-angle esotropia or hypotropia. In contrast, heavy eye syndrome, also called myopic strabismus fixus, is characterized by profound esotropia and hypotropia with the eyeball fixed nasally. We report the case of a 71-year-old man with sagging eye syndrome presenting with strabismus fixus and no myopia.