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Duane Retraction Syndrome
- 1. Duane’s Retraction Syndrome DrSunayana Bhat Consultant Paediatric ophthalmology , Strabismus and Neuro ophthalmology Vasan eye care , Mangalore Ph : 9611102754 [email protected]
- 2. Historical Background • Duanesyndrome 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 TypeI: OS -limited abduction -retraction in adduction
- 5. Duane’s Syndrome TypeII: OS -limited adduction -retraction in adduction
- 6. Duane’s Syndrome TypeIII: OS -limited adduction and abduction -retraction in adduction/abduction
- 7. History • Squinting • Headtilt • Loss of binocular vision • Reduced ocular movement • Facial asymmetry • Picture of paralytic squint
- 8. Epidemiology • 1% ofall 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
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- 14. Differentials DRS Sixth Npalsy • ET small angle • Narrowing • Saccadic velocities • ET large angle • -ve • Slow in abduction only
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- 16. Treatment • Treat refractiveerror /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. Made simple … EsoDRS Small angle <15 PD Single MR recession Larger angle Bilateral MR recession Asymmetric
- 19. Exo DRS Small angle<15 PD Single LR recession Larger angle Bilateral LR recession Symmetric
- 20. Upshoots Downshoots Globe retraction Recession ofMR and LR Y split Posterior fixation suture to LR
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- 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
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