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’
الموقع المصري للحول
وامراض الجهاز الحركي للعين
The Egyptian Site of
Strabismus & Oculomotor Disorders
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