Duane Syndrome Differential Diagnoses

Updated: Mar 20, 2023
  • Author: Arun Verma, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Diagnostic Considerations

Disorders similar in presentation to Duane syndrome (DS) can be acquired as a result of trauma or following localized infection of the orbit leading to inflammation and consequent mechanical restrictions of eye movement. In such cases, a thorough history usually will help in distinguishing between these conditions. In the clinical setting, the principal difficulties in differential diagnosis arise as a consequence of the very early age at which patients with this condition first present. The clinician must be persistent in examining abduction and adduction, as well as in looking for any associated palpebral fissure changes or head postures, when attempting to determine whether what often presents as a common childhood squint is, in fact, Duane syndrome. Fissure changes and the other associated characteristics of Duane syndrome, such as upshoots or downshoots and globe retraction, are vital when deciding whether any abduction limitation is the result of Duane syndrome and not a consequence of cranial nerve VI or abducens cranial nerve palsy.

Duane syndrome with radial-ray anomalies (see also Differential Diagnosis and other problems to be considered in the Physical section)

Moebius syndrome

Congenital or familiar esotropia

Congenital oculomotor apraxia

Epicanthal folds

Convergence or accommodative excess

Orbital pseudotumor

Grave disease

Ocular anomalies commonly associated with Duane syndrome

Dysplasia of the iris stroma

Papillary anomalies




Crocodile tears


Systemic anomalies

Goldenhar syndrome

Klippel-Feil anomalad

Congenital labyrinthine deafness

Differential Diagnoses