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Duane's syndrome
Last reviewed: 07.07.2025
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The hallmark of Duane's syndrome is retraction of the eyeball during attempted adduction, caused by simultaneous contraction of the internal and external rectus muscles. The condition is generally bilateral, although symptoms in one eye are often so minimal that they go unnoticed. In some cases, it is associated with congenital developmental anomalies; most commonly, with sensorineural hearing loss and speech disorders.
[ Symptoms of Duane Syndrome
Signs that may occur with each of the three types:
- When attempting adduction, retraction of the eyeball occurs, caused by simultaneous contraction of the internal and external rectus muscles, accompanied by narrowing of the palpebral fissure. The degree of retraction of the eyeball varies from insignificant to pronounced. When attempting abduction, the palpebral fissure opens and the eyeball acquires a normal position.
- Upward and downward deviation in adduction occurs in some patients. This "frenulum" (or "tether") phenomenon is thought to be due to the short external rectus muscle slipping over or under the globe and causing abnormal vertical deviation. However, recent MRI studies have shown that this is not always the case.
The external rectus muscle on the affected side is resected, which increases retraction.
Huber's classification of Duane syndrome
Type I, the most common:
- Limited or absent abduction.
- Normal or slightly limited adduction.
- In the primary position - correct position of the eyes or slight esotropia.
Type II, the rarest:
- Limited adduction.
- Normal or slightly limited abduction.
- In the primary position - correct position of the eyes or slight exotropia.
Type III:
- Limitation of adduction and abduction.
- In the primary position - correct position of the eyes or mild esotropia.
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Treatment of Duane syndrome
In most cases, the position of the eyes is correct, so amblyopia does not occur. Surgical intervention is indicated when the eyeballs are deviated in the primary position and the head position is forced to maintain fusion. It may also be indicated when there are cosmetically unsatisfactory upward, downward deviations or severe retraction of the eyeball. Amblyopia usually develops due to anisometropia, not strabismus.