Duane Retraction Syndrome

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

2. 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

3. Pathophysiology
“ Musculo Fascial
Innervational
Anomaly ”
Fibrosis of LR/MR
Fibrous bands
Co contraction –
paradoxical innervation

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

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

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

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

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

9. 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

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

11. Syndromes
• Okihiro syndrome
• Wildervanck syndrome
• Holt-Oram syndrome
• morning-glory syndrome
• Goldenhar syndrome.
• congenital labyrinthine deafness.
Klippel-Feil anomaly

12. Variants
• Bilateral DRS

13. Inverse DRS

14. Differentials
DRS Sixth N palsy
• ET small angle
• Narrowing
• Saccadic velocities
• ET large angle
• -ve
• Slow in abduction only

15. Differentials
• Mobius syndrome

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

17. 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 ”

18. Made simple …
Eso DRS
Small angle <15
PD
Single MR
recession
Larger angle
Bilateral MR
recession
Asymmetric

19. Exo DRS
Small angle <15
PD
Single LR
recession
Larger angle
Bilateral LR
recession
Symmetric

20. Upshoots
Downshoots
Globe retraction
Recession of MR
and LR
Y split
Posterior fixation
suture to LR

21. Duction
Improvement
Transposition of
SR /IR
FOSTER’S
modification

22. 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

23. Thank u