Case of the week 18 (
December 2011
) Duane Syndrome Type I
Parents of this 7 years old boy are becoming
increasingly uncomfortable about the way he looks.
They complain that his eyes just don't ‘look like
they should’. Specifically they states that his left
eye looks obviously smaller and that it does not go all the
way to the left. They noticed this abnormal looking
shortly after birth
VA, fundus and refraction show no significant data
Apart from this ocular abnormality , he is healthy ,
intelligent , talkative
and very nice boy
See the video of this patient
This is an example of Class I Duane syndrome. There is a
left esotropia in the primary position, limited abduction in
the left eye, and marked narrowing of the left palpebral
fissure on right gaze. The boy doesn't have left face turn
as I usually find in such cases , I assume he has a fusion
problem.
As the constant rules In the literature , reasonable Duane
features are found in this case make him a good candidate
for surgical interference , these are deviation in the
primary position and the disfiguring narrowing on right gaze
which is actually annoys the parents
This may be treated surgically with a recession of the left
medial rectus muscle and possibly with a posterior fixation
suture on the right medial rectus to limit excursion in left
gaze making the eyes more nearly ‘matched’ in that gaze
position. The enophthalmos could be treated by detaching of
the Lt lateral rectus , wide Y splitting and reattaching it
along the upper and lower border of the original insertion .
Finally in a case like this, it is always necessary to rule
out a left sixth nerve palsy. The narrowing of the left
palpebral fissure with enophthalmos helps confirm Duane.
This would not occur in a sixth nerve palsy.
الموقع المصري للحول
وامراض الجهاز الحركي للعين
The Egyptian Site of
Strabismus & Oculomotor Disorders
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