Duane’s Retraction Syndrome Dr Sunayana Bhat Consultant Paediatric ophthalmology , Strabismus and Neuro ophthalmology Vasan eye care , Mangalore Ph : 9611102754chanyn9@gmail.com

Historical Background • Duane syndrome is a rare, congenital disorder of eye

movement

• Stilling and Turk : described it first • Duane popularised it

Classic features

Limitation of abduction

Slight limitation of adduction

Retraction of globe on adduction

Adduction narrowing of palpebral fissure

Upshoot / downshoot of eye in adduction

Pathophysiology

Duane’s Syndrome Type I: OS-limited abduction-retraction in adduction

Duane’s Syndrome Type II: OS-limited adduction -retraction in adduction

Duane’s Syndrome Type III: OS-limited adduction and abduction -retraction in adduction/abduction

History• Squinting • Head tilt• Loss of binocular vision• Reduced ocular movement • Facial asymmetry• Picture of paralytic squint

Epidemiology • 1% of all cases of strabismus• Sporadic • Unilateral 60% • Left eye • Female preponderance

Clinical Picture• AHP • Strabismus ( 77% of cases)• Globe retraction• Palpebral fissure narrowing

• Anisometropia /amblyopia • Sensory adaptation with excellent binocular functions

-directions of gaze where visual axes are aligned -suppression without diplopia in gaze of abnormal muscle

Associated Anomalies • Skeletal• Auricular• Ocular -dysplasia of the iris stroma, -pupillary anomalies -cataracts - heterochromia - Marcus Gunn jaw-winking -coloboma - crocodile tears -microphthalmos.• Neural

Syndromes • Okihiro syndrome• Wildervanck syndrome• Holt-Oram syndrome• morning-glory syndrome• Goldenhar syndrome.• congenital labyrinthine deafness.

Klippel-Feil anomaly

Variants • Bilateral DRS

Inverse DRS

Differentials DRS Sixth N palsy

• ET small angle

• Narrowing

• Saccadic velocities

• ET large angle

• -ve

• Slow in abduction only

Differentials

•Mobius syndrome

Treatment • Treat refractive error /amblyopia • Conservative : Age 5-6 yrs

Indications for surgery• Anomalous head posture• Strabismus in primary gaze• Significant upshoot or downshoot in adduction• Cosmetically significant palpebral fissure narrowing in

adduction.

“ Limited Goals ”

Made simple …

Carry home message • Diagnosis often elusive SO LOOK for it !• Treat Ref Error , amblyopia • Risk benefit ratio of surgery to be well understood by patients

and surgeon • Tailor made surgery required for every case

Thank u