Background Esotropia due to high myopia can be caused by inferior shift of the lateral rectus muscle (LRM). Innovative surgical methods have been developed to elevate the muscle and, thus, augment its abducting force. However, their efficacy is not yet proven to exceed that of recess–resect surgery (RR).

Methods Data on high myopic esotropia were evaluated who received RR together with elevation of the LRM in the horizontal meridian by equatorial myopexy. Age, gender, axial length, amount of surgery, preoperative and 3 months postoperative strabismus angles and efficacy (mm/°) were analysed. Medians and ranges (minimum–maximum) are given.

Results The age of the 46 patients (37 females, 9 males) was 57 years (36–76). Axial length was 31.5 mm (26.0–35.6), total amount of RR 10.0 mm (5–24). Esotropia 16° (4–60) was reduced to 2° (−22 to 34), hypotropia from 3° (−3 to 30) to 0° (−8 to 18). Efficacy (eyes without prior surgery only) was 1.33°/mm (0.20–3.55).

Conclusions Geometrical considerations rather than empirical data yield some evidence of an augmenting effect of equatorial myopexy on RR. Efficacy of RR with LRM myopexy was higher in unilateral than bilateral high myopia. Strict indication for myopexy appears appropriate.