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Duane’s Retraction Syndrome

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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

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