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Purpose: To present a challenging case of heavy eye syndrome (HES) in a 56-year-old female who previously underwent scleral buckle surgery in both eyes. Observations: Ophthalmic tests indicated a diagnosis of HES, confirmed using pre and postoperative magnetic resonance imaging (MRI). A silicone band loop myopexy was performed, successfully improving large angle esotropia at primary position and motility. Conclusions and Importance: MRI is essential to correctly identify HES, allowing a tailored surgical intervention that may lead to better outcomes for patients. Up to our knowledge, this is the first reported case of scleral fixated silicone band loop myopexy for HES in a previously scleral buckled patient.