1. Bilateral Duane’s syndrome
OMC unit

2. Case presentation

3. Duane’s retraction syndrome
Core problem – LR has double innervation
3rd nerve & th nerve
 MR & LR co-fire on aDduction - determines retraction
Clinical presentation depends on:
how aberrant is LR innervation [% of 3rd vs. % of 6th]
How tight the MR / LR become

4. Usual pattern: “Type 1” restricted ABduction some ET some retraction
ET retraction on
ADduction
Limitation of ABduction
Face turn
ABduction restricted  LR innervation
tight MR ‘chronic ET
ADduction restricted tight LR

5. Clinical presentation depends on balance of abnormal innervation to LR
LR innervation
3 N N
30% %
ET – less
Some retraction on ADduction
LR innervation
3N N
70% %
ET more
More retraction on ADduction
ABduction restricted LR innervation
tight MR ‘chronic ET’
ADduction restricted tight LR

6. TREATMENT Traditional: ipsi MR recession. No long term follow up
Strabismus specialists rarely do this  iatrogenic “Type 3”
Usual surgery: contralateral MR Rc, or
transposition of SR & IR
Up & downshoot ipsi LR Rc & split
Severe retraction LR fixation to periosteum & SR - IR transposition