Duane Syndrome Follow-up

  • Author: Arun Verma, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Nov 17, 2011
 

Complications

Undercorrection of the primary position esotropia and face turn probably is the most common adverse outcome after surgical treatment of DS, especially when surgeons use amounts of recession typical of their experience in treating concomitant esotropia.

Undercorrection may be obvious in the immediate postoperative period, or the face turn may reappear years after what initially appeared to be a good result. The face turn is presumably due to contracture of the ipsilateral medial rectus muscle.

Undercorrection can be managed by means of vertical rectus transposition or by means of repeat recession of the medial rectus muscle, if the initial recession was relatively small (< 8 mm). Repeat recession of the medial rectus is necessary if passive duction testing still indicates restriction.

With the large recessions necessary to treat DS, overcorrection occasionally occurs. Treatment of this secondary exotropia consists of advancement of the recessed medial rectus muscle or recession of the lateral rectus muscle, particularly if passive ductions indicate tightness of the lateral rectus muscles.

New vertical deviations may result from vertical rectus transposition. This condition is treated with (1) dissection (which involves considerable scar tissue) and recession of the appropriate transposed vertical rectus muscle in the ipsilateral eye, particularly if vertical passive ductions are positive, or (2) recession of the appropriate vertical rectus muscle in the contralateral eye.

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Prognosis

The prognosis of surgery is not good; therefore, it is best to avoid surgery if patients have some form of binocular vision.

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Patient Education

Patients must be taught to learn some form of head tilt and orthoptic training to have some binocular vision.

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Contributor Information and Disclosures
Author

Arun Verma, MD  Senior Consultant, Department of Ophthalmology, Dr Daljit Singh Eye Hospital, India

Disclosure: Nothing to disclose.

Specialty Editor Board

Gerhard W Cibis, MD  Clinical Professor, Director of Pediatric Ophthalmology Service, Department of Ophthalmology, University of Kansas School of Medicine

Gerhard W Cibis, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, and American Ophthalmological Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

J James Rowsey, MD  Former Director of Corneal Services, St Luke's Cataract and Laser Institute

J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Pan-American Association of Ophthalmology, Sigma Xi, and Southern Medical Association

Disclosure: Nothing to disclose.

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

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Duane syndrome.
Duane syndrome.
An individual diagnosed with Duane syndrome in the left eye. In this image, the affected person is attempting to look far right. Notice the afflicted left eye faces straight and up (an "upshoot"), rather than following the right eye to the right.
Table. Types of DS
CategoryDescription
Type
1 (70%-80%)Inability to abduct



Normal or minimal defect in adduction



Esotropia with head straight



A or V pattern



Usually updrift or a downdrift of affected eye on adduction or attempted abduction



Globe retraction and palpebral-fissure narrowing on adduction



Usual face turn to affected side



Normal stereo possible



2 (about 7%)Inability to adduct



Normal or minimal defect in abduction



Exotropia of the affected eye



Marked upshoot



Globe retraction and palpebral-fissure narrowing on adduction



Stereo normal or suppressed



Face turn to normal side



3 (about 15%)Inability ability to abduct and adduct



Globe retraction and palpebral-fissure narrowing on attempted adduction



Possible upshoot and downshoot on adduction



Straight or nearly straight head position



Usually, normal stereo



4Not usual DS or DS-type appearance



Large-angle exotropia



Face turn to uninvolved side



Limited adduction



Simultaneous abduction when looking toward uninvolved side



Usually suppresses 1 eye



Subtype
AAffected eye turned inward toward the nose (esotropia)
BAffected eye turned outward toward the ear (exotropia)
CEyes in a straight primary position
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