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Case of the week 60 ( June 2012 )
Duane Syndrome Type II to III ( Exotropic Duane )

This 28 years old man complains of the out deviation of his left eye , he noted that this deviation was noticed shortly after birth , VA is 6/6  OD   6/6   OS
He is about to have a good job abroad but aligned eyes is a must to pass the interview

 See video of this patient

This patient has Lt eye Type  II to III  Duane syndrome since there is marked limited adduction with - for me - minimal limited abduction. In my opinion there is no DD for duane syndrome type III . it is the only oculomotor disorder in which there is limitation of both abduction and adduction with retraction of the globe on attempt adduction with or without ET / XT and with or without up / down shooting on attempt adduction  .
Of course other causes of limited ductions and upshoot on adduction should be kept in mind
This man is  ‘exotropic’ in primary position with an upshot in adduction and disfiguring narrowing . In cases of duane syndrome if the enophthalmos and upshoot become enough of a problem like here in this patient , surgery on the left eye could be done consisting of a recession of the left lateral rectus with a ‘Y’ split and recession of the left medial rectus , this recession of both horizontal recti should be done un-proportional where more recession of the LR is put in mind to correct the exotropia , this procedure will correct the disfiguring narrowing and  the exotropia , also  the upshooting in far right gaze will be corrected . 
This man can find double vision in some gazes as can virtually all Duane patients both before and after even successful surgery.
In every case of Duane Syndrome you must remember : Patients with Duane can be made better but not ‘perfect’

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