Duane‘s Retraction

Syndrome

Siraj Safi

Lecturer in optometry

Duane‘s retraction syndrome

This syndrome was first described by

Stilling (1887) and Turk (1896) and is

also known as the Stilling-Turk-

Duane’s syndrome.

Duane (1905) discussed the disorder

in more detail and it became generally

known as Duane’s retraction

syndrome.

Duane‘s retraction syndrome

The retraction syndrome is a

congenital disorder and has been

reported in a neonate aged just 1 day

(Archer et al. 1989)

Despite its congenital origin it is rarely

recognized until later in childhood,

when defective eye movement or an

obvious compensatory head posture

brings it to attention

Duane‘s retraction syndrome

The syndrome is thought to be

unilateral in approximately 80% of

cases, but since bilateral Duane’s

syndrome is usually markedly

asymmetrical

The left eye is affected more than

twice as frequently as the right eye.

Females show a slightly higher

incidence than males

Aetiology

Evidence has been presented which

strongly suggests that the findings in

Duane’s retraction syndrome are due

to innervation of the lateral rectus by

extra branches of the third nerve in

place of absent or deficient sixth nerve

fibers.

Aetiology

Huber suggested that in Duane’s

syndrome the lateral rectus could

have three parts:

a normally innervated portion;

a portion innervated by the third nerve;

a denervated and therefore fibrotic

portion.

Aetiology

Co-contraction theory:

The L.R is partially innervated by the

III rd nerve with or without VI nerve

innervation. This produces co-

contraction of the M.R & L.R on

adduction & limited adduction with

retraction of the globe

Features

• Limited abduction occurs to a variable

degree & limited adduction occurs often to

a lesser degree.

• Retraction of the globe on adduction with

narrowing of P.F is often noted.

• Widening of P.F may be seen on

attempting Abd.

• Up shoots are more common than down

shoots and occur because of globe

slipping of the tight horizontal recti over

the globe.

Features

the common head posture is a face

turn to the affected side, more marked

for distance fixation

Manifest strabismus, usually

esotropia, when the head is straight

Absence of diplopia

Convergence deficiency is sometimes

present when there is significant

limitation of adduction

Classification

Brown (1950) and Huber (1974) have

classified

Duane’s syndrome according to the

characteristics of the limitation of

movement.

BROWN’S CLASSIFICATION

Type A: with limited abduction and less-marked limitation of adduction

Type B: showing limited abduction but normal adduction.

Type C: in which the limitation of adduction exceeds the limitation of abduction.

HUBER’S CLASSIFICATION

Duane (type) 1:

characterized by marked limitation of abduction.

Duane (type) 11:

characterized by limitation of adduction.

Duane (type) 111:

characterized by limitation of both abduction and adduction.

Diagnosis

The cover test

Ocular movements should be tested

Changes in lid and globe position on horizontal gaze should be carefully assessed

The deviation should be measured fixing with each eye

Confirmation of binocular single vision

Hess chart

The presence or absence of diplopia

FDT

Duane’s Syndrome Type I: OS

limited abduction,

retraction in adduction

G.Vicente

Duane’s Syndrome Type I

limited abduction,

retraction in adduction: superior view

notice co-contraction of LMR & LLR

Dr. G.Vicente

OS OD

Duane’s Syndrome Type I

retraction in adduction limited abduction, superior view

OS OD

G.Vicente

Duane’s Syndrome Type II: OS

limited adduction

retraction in adduction

G.Vicente

Duane’s Syndrome Type III: OS

limited adduction and abduction

retraction in adduction

G.Vicente

Differential diagnosis

Congenital sixth nerve palsy

Infantile esotropia

Mobius‘ syndrome

Liberal resection of the lateral rectus

Management

The majority of patients with Duane’s

syndrome maintain comfortable

binocular single vision and remain

compensated, usually with a

comparatively slight face turn.

Surgical treatment is therefore

required in only a few cases.

Surgery indication

Surgery is indicated for the following reasons:

Decompensation, giving rise to manifest strabismus

A cosmetically poor compensatory head posture;

A cosmetically poor manifest strabismus, most often

Severe globe retraction with or without up-shoot and down-shoot.

Surgical treatment

The aims of surgery are:

To correct a manifest strabismus

To centralize the field of binocular

single vision,

to overcome or reduce the need for a

large compensatory head posture

Surgical treatment

Duane’s syndrome with esotropia

Esotropia not greater than 15 Pd:

ipsilateral medial rectus recession 5 mm.

Esotropia between 15 and 25 Pd: ipsilateral medial rectus recession 5 mm; contralateral medial rectus recession 3 mm.

Esotropia 25 Pd or greater:

bilateral medial rectus recession 5 mm

Surgical treatment

Duane’s syndrome with exotropia

Duane’s syndrome with exotropia is

comparatively rare

Surgery comprises a recession of the

lateral rectus muscle according to the

deviation in the primary position

RETRACTION OF THE GLOBE ON

ADDUCTION

The most severe globe retraction is

found in Duane’s type 11 and 111.

Surgical treatment comprises

recession of the lateral rectus muscle

in the affected eye from 8 to10 mm if

there is any up shoot or down shoot

Y-splitting procedure may be require

with recession of the LR.

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