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Review
. 2019 Jan;67(1):16-22.
doi: 10.4103/ijo.IJO_967_18.

Management of Duane retraction syndrome: A simplified approach

Nripen Gaur  1 , Pradeep Sharma  1
Affiliations
Review

Management of Duane retraction syndrome: A simplified approach

Nripen Gaur et al. Indian J Ophthalmol. 2019 Jan.

Abstract

Duane retraction (or co-contraction) syndrome is a congenital restrictive strabismus which can occur either as an isolated entity or in conjunction with other congenital anomalies and is now listed as a congenital cranial dysinnervation disorder. It is characterized by co-contraction of horizontal recti on attempted adduction causing globe retraction along with variable amounts of upshoots or downshoots. It may have limited abduction or adduction or both and present as esotropic, exotropic, or orthotropic Duane. The diagnosis of this disease is usually clinical. However, recent research has provided a greater insight into the genetic basis of this disease paving a way for a greater role of genetics in the diagnosis and management. This disease can have a varied presentation and hence the treatment plan should be tailor-made for every patient. The indications for surgery are abnormal head posture, deviations in the primary position, retraction and narrowing of palpebral aperture and up- or downshoots during adduction, and sometimes also to improve abduction. The arrival of newer surgical techniques of periosteal fixation (PF) of lateral rectus (LR), partial vertical rectus transposition, or superior or inferior rectus transposition in addition to LR recession with Y-split has vastly improved the management outcomes, providing not only primary position orthophoria but also increased binocular visual fields as well.

Keywords: Duane retraction syndrome; restrictive strabismus; strabismus surgery.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
(a) Preoperative photograph of a patient with left eye eso-DRS. The patient underwent MR recession in the affected eye leading to orthophoria in the postoperative period, corrected downshoot, but has some adduction deficit (b)
Figure 2
Figure 2
(a) Abduction deficit in a patient with left eso-DRS successfully managed by SRT alone (b)
Figure 3
Figure 3
Flow diagram summarizing management of eso-DRS
Figure 4
Figure 4
(a) Severe upshoots in a patient with left exo-DRS managed effectively by left LR recession with Y-split (b)
Figure 5
Figure 5
(a) Preoperative photograph of a patient with left eye exo-DRS. The patient underwent supramaximal LR recession (15 mm) in the affected eye leading to the improvement in exodeviation but sill a residual exotropia was present (b) which was corrected by LR recession in the other eye leading to orthophoria (c)
Figure 6
Figure 6
(a) Consecutive esotropia in a patient with exo-DRS managed with PF earlier, which was managed successfully by pVRT leading to improved abduction, but has residual upshoot in adduction (b)
Figure 7
Figure 7
Flow diagram summarizing management of exo-DRS
Figure 8
Figure 8
(a) Preoperative clinical photograph of a patient having ortho-DRS with upshoot managed successfully with medial rectus recession and lateral rectus recession with Y-split (b)
Figure 9
Figure 9
(a) Preoperative clinical photograph of a patient having bilateral eso-DRS managed successfully with bilateral MR recessions (b)
See this image and copyright information in PMC

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