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Duane’s Retraction Syndrome Dr Sunayana Bhat Consultant Paediatric ophthalmology , Strabismus and Neuro ophthalmology Vasan eye care , Mangalore Ph : [email protected]
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
