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Case of the week 62  ( July 2012 )
 Duane Syndrome Type II


This girl is becoming increasingly uncomfortable about the way she looks. She complains that her eyes just don't ‘look like they should’. Specifically she states that her right eye does not go all the way to the left and her left eye does not go all the way to the right. She sometimes  experiences double vision when she looks to the left.

Vision: OD 20/20,        OS 20/20
Refraction:        OD +0.25 -1.25 x 180 degrees       OS +0.25
Stereo: fly (3000 sec.)


 See video of this patient
 


This patient has Lt eye Type  II  Duane syndrome since there is marked limited adduction with marked upshoot.
Of course other causes of limited ductions and upshoot on adduction should be kept in mind
This girl is  ‘exotropic’ in primary position - exotropic Duane - with an upshot in adduction  . In cases of duane syndrome if the 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 together with recession of the Right LR , this procedure will correct the exotropia , also  the upshooting in far right gaze will be corrected . 
This girl 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’
 
Now this is our patient post operative

 See video of this patient Post operative
 

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