7/21/2019 Bilateral Duane's Syndrome Pr

http://slidepdf.com/reader/full/bilateral-duanes-syndrome-pr 1/5

7/21/2019 Bilateral Duane's Syndrome Pr

http://slidepdf.com/reader/full/bilateral-duanes-syndrome-pr 2/5

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

http://slidepdf.com/reader/full/bilateral-duanes-syndrome-pr 3/5

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

http://slidepdf.com/reader/full/bilateral-duanes-syndrome-pr 4/5

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

7/21/2019 Bilateral Duane's Syndrome Pr

http://slidepdf.com/reader/full/bilateral-duanes-syndrome-pr 5/5

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