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Duane’s Retraction Syndrome

Duane’s Retraction Syndrome. Dr Sunayana Bhat Consultant Paediatric ophthalmology , Strabismus and Neuro ophthalmology Vasan eye care , Mangalore Ph : 9611102754 chanyn9@gmail.com. Historical Background. Duane syndrome is a rare, congenital disorder of eye movement

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Duane’s Retraction Syndrome

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  1. Duane’s Retraction Syndrome Dr SunayanaBhat Consultant Paediatric ophthalmology , Strabismus and Neuro ophthalmology Vasan eye care , Mangalore Ph : 9611102754 chanyn9@gmail.com

  2. Historical Background • Duane syndrome is a rare, congenital disorder of eye movement • Stilling and Turk : described it first • Duane popularised it

  3. Pathophysiology

  4. Duane’s Syndrome Type I: OS-limited abduction-retraction in adduction

  5. Duane’s Syndrome Type II: OS-limited adduction -retraction in adduction

  6. Duane’s Syndrome Type III: OS-limited adduction and abduction -retraction in adduction/abduction

  7. History • Squinting • Head tilt • Loss of binocular vision • Reduced ocular movement • Facial asymmetry • Picture of paralytic squint

  8. Epidemiology • 1% of all 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

  12. Variants • Bilateral DRS

  13. Inverse DRS

  14. Differentials DRS Sixth N palsy • ET small angle • Narrowing • Saccadic velocities • ET large angle • -ve • Slow in abduction only

  15. Differentials Mobius syndrome

  16. Treatment • Treat refractive error /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 …

  19. 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

  20. Thank u

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