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Case of the week 178  ( June 2014 )
Duane Syndrome Type I


This 42 year old woman is becoming increasingly uncomfortable about the way she looks. She complains of inward deviation of her eyes since early child hood. Now, she wants her eyes to be straightened.

Vision: OD 20/20, OS 20/20
Refraction:

OD +0.25 -1.25 x 180 degrees , OS +0.25




Duane Syndrome Type I
This is an example of Class I Duane syndrome. There is  esotropia in the primary position, limited abduction in the left eye, and narrowing of the left palpebral fissure on right gaze.
As the constant rules In the literature , reasonable Duane features are found in this case make her a good candidate for surgical interference , these are deviation in the primary position and the narrowing on right gaze which is actually annoys the patient. 
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 narrowing 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.

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