Duane Retraction Syndrome

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Mechanism

  • Lateral rectus not innervated by the abducens nerve
  • Misdirection of oculomotor fibers into the lateral rectus

Findings

  • Limited abduction and/or adduction
  • Globe retraction with attempted adduction
  • Up-shoot or down-shoot in adduction
  • Compensatory head turn to avoid diplopia

Classification (Huber)

  • Type I: restricted or absent abduction (most common)
  • Type II: restricted adduction (least common)
  • Type III: restricted adduction and abduction
  • Mnemonic: Type = amount of “d”
    • Type 1: Abduction; Type 2: Adduction; Type 3: Adduction and Abduction

Associations

  • Deafness
  • Syndromes: Goldenhaar Syndrome, Klippel-Feil Syndrome, fetal alcohol syndrome
  • Thalidomide toxicity

Treatment

  • Correction of refractive errors
  • Treat amblyopia
  • Surgery only in the case of bothersome head turn in primary position (avoid muscle resections -> increases restriction!)

Sources

  • EyeWiki Duane Retraction Syndrome
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
  • Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)