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7/21/2019 Bilateral Duane's Syndrome Pr
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7/21/2019 Bilateral Duane's Syndrome Pr
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DuaneDuane’’s retraction syndromes retraction syndrome
Core problem – LR has double innervation
3rd nerve&
6th nerve
⇒ MR & LR co-fire on aDduction - determines retraction
Clinical presentation depends on:
- how aberrant is LR innervation [% of 3rd vs. % of 6th]
- How tiht the !R " LR become
7/21/2019 Bilateral Duane's Syndrome Pr
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Clinical presentation depends on balanceClinical presentation depends on balance
of abnormal innervation to LRof abnormal innervation to LR
LR innervation
3 N 6N
3#% $#%
& ' less
(ome retraction on
)*d+ction
LR innervation
3N 6N
$#% 3#%
& more
!ore retraction on
)*d+ction
ABduction restricted LR innervation
tiht !R ,chronic &
ADduction restricted tiht LR
7/21/2019 Bilateral Duane's Syndrome Pr
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Usual patternUsual
pattern:: ““Type 1Type 1
restricted ABduction restricted ABduction
some ET some ET
some retraction some retraction
Face turnFace turn !nilateral patterns:- /odeviation 0restricted )*d+ction1 with or witho+t +p2 downshoot- Relativel immobile lobe in 44 with mar5ed retraction +p2 downshoot
- (im+ltaneo+s abd+ction of each ee
Bilateral patterns- 7ilateral *( with f+sion- 7ilateral *( witho+t f+sion mar5ed &
mar5ed 8&
LimitationLimitation
ofof
)7d+ction)7d+ction
&
retraction on)*d+ction
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TREATMENTTREATMENT"raditional# ipsi MR recession$ 9o lon term follow +p
(trabism+s specialists rarel do this→ iatroenic &pe 3;
<s+al s+rer: contralateral !R Rc or
transposition of (R 2 =R
<p 2 downshoot ipsi LR Rc 2 split
(evere retraction LR fi/ation to perioste+m 2
(R - =R transposition