Duanes Retraction Syndrome Dr Sunayana Bhat Consultant Paediatric

Duane’s Retraction Syndrome Dr Sunayana Bhat Consultant Paediatric ophthalmology , Strabismus and Neuro ophthalmology Vasan eye care , Mangalore Ph : 9611102754 chanyn 9@gmail. com

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 “ Musculo Fascial Innervational Anomaly ” Fibrosis of LR/MR 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 Globe retraction Y split 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