Home Page Strabismus Course Strabismus Books Strabismus Videos

Strabismus Lectures Case of the week E Consultation Contact me


 Case of the week 12 ( November 2011 )
 Duane Syndrome Type III

This 14 years old girl

Vision: OD 20/20, OS 20/20
Refraction: OD +o.75   OS +0.25
Stereo: fly (3000 sec)

This girl has been noted by her parents to have a face turn to the right . They do not notice anything else about her eyes. She is otherwise healthy and has no complaints.



 See the video examination of this girl



This girl has Lt eye Type  III  Duane syndrome . 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 face turn , limited ductions and upshoot on adduction should be kept in mind :


Strabismus Course : 17. Decision Making

This girl is  ‘orthotropic’ in primary position with a prominent upshot in adduction, the right face turn is to avoid diplopia on looking right  . Because she has good stereopsis and no complaints, any surgical treatment should take these two facts into consideration. If the enophthalmos and upshoot become enough of a problem, 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 will correct both the disfiguring narrowing and  the main problem with this girl’s appearance which is the upshooting in far right gaze seen in picture 4.  This girl can find double vision 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’

( The results of surgical treatment of the retraction syndrome often have been disappointing. For this reason, we prefer not to operate when binocular vision is present with the eyes in primary position or if it can be maintained with only a slight head turn. Surgery is indicated only when there is a significant deviation in primary position or if the face turn is intolerable from a cosmetic or functional point of view. The patient must be informed that there is no surgical procedure that will restore normal ocular excursions in all gaze positions  )    Von Noorden Binocular Vision and Ocular Motility

الموقع المصري للحول وامراض الجهاز الحركي للعين

The Egyptian Site of Strabismus & Oculomotor Disorders