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Duane’s Retraction Syndrome Dr Sunayana Bhat Consultant Paediatric ophthalmology , Strabismus and Neuro ophthalmology Vasan eye care , Mangalore Ph : 9611102754 [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 Fibrosis of LR/MR “ Musculo Fascial Innervational Anomaly ” Fibrous bands Co contraction – paradoxical innervation 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 • ET large angle • Narrowing • -ve • Saccadic velocities • 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 … Small angle <15 PD Single MR recession Larger angle Bilateral MR recession Eso DRS Asymmetric Small angle <15 PD Single LR recession Larger angle Bilateral LR recession Exo DRS Symmetric Recession of MR and LR Upshoots Downshoots Y split Globe retraction Posterior fixation suture to LR Transposition of SR /IR Duction Improvement FOSTER’S modification 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
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