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Myopic strabismus fixus (MSF) is an acquired, progressive form of strabismus associated with high myopia. It is typically characterised by an esotropia-hypotropia or exotropia-hypotropia complex. We present a sporadic case of a middle-aged adult male with high myopia, who exhibited an esotropia-hypertropia complex in both eyes. MRI revealed an atypical protrusion of the posterior globe in the inferotemporal quadrant, displacing the muscle paths of the lateral and inferior rectus muscles. This case demonstrates how inferotemporal silicone band loop myopexy can achieve good ocular alignment and improved extraocular motility in this rare form of MSF.