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Duane retraction syndrome: causes, effects and management strategies

Authors Kekunnaya R, Negalur M

Received 3 June 2017

Accepted for publication 5 September 2017

Published 30 October 2017 Volume 2017:11 Pages 1917—1930

DOI https://doi.org/10.2147/OPTH.S127481

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Ramesh Kekunnaya, Mithila Negalur

Pediatric Ophthalmology and Strabismus Services, Child Sight Institute, Jasti V Ramannama Children’s Eye Care Center, KAR Campus, Hyderabad, India

Abstract: Duane retraction syndrome (DRS) is a congenital eye movement anomaly characterized by variable horizontal duction deficits, with narrowing of the palpebral fissure and globe retraction on attempted adduction, occasionally accompanied by upshoot or downshoot. The etiopathogenesis of this condition can be explained by a spectrum of mechanical, innervational, neurologic and genetic abnormalities occurring independently or which influence each other giving rise to patterns of clinical presentations along with a complex set of ocular and systemic anomalies. Huber type I DRS is the most common form of DRS with an earlier presentation, while Huber type II is the least common presentation. Usually, patients with unilateral type I Duane syndrome have esotropia more frequently than exotropia, those with type II have exotropia and those with type III have esotropia and exotropia occurring equally common. Cases of bilateral DRS may have variable presentation depending upon the type of presentation in each eye. As regards its management, DRS classification based on primary position deviation as esotropic, exotropic or orthotropic is more relevant than Huber’s classification before planning surgery. Surgical approach to these patients is challenging and must be individualized based on the amount of ocular deviation, abnormal head position, associated globe retraction and overshoots.

Keywords: Duane syndrome, strabismus surgery, esotropia, overshoots

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