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

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 ET small angle Narrowing Saccadic velocities
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. Bilateral MR recession
Made simple …
Eso DRS
Small angle <15 PD
Single MR recession
Larger angle
Bilateral MR recession
Asymmetric

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

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

21. Transposition of SR /IR FOSTER’S modification
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