All About Strabismus
by Dr. Jeffrey Cooper & Rachel Cooper (no relation). © 2001-2008

Duane's Syndrome

Duane's Syndrome (type I)

Duane's syndrome (type I) is made up of three parts: an inability to move an eye laterally away from the nose with widening of the eyes (palpebral fissure), retraction of the eye when attempting to look close or towards ones nose; and retraction of the eye. In the picture above the left eye can not look left while in the picture below, the eye moves back in the socket with narrowing of the aperture of the eyes. There are two other uncommon types of Duanes: Duane II where by the eye has trouble looking toward the nose (opposite to Duane's I); and Duane III made up of a combination of I and II. A patient with Duane's is likely to have an eye turn inwards at distance.

Duane's Syndrome (type I)

It may be confused with a paralysis of the muscle which causes the eye to turn outwards (lateral rectus) resulting in an unnecessary neurological workup. Duane's is usually congenital and may be associated with other congenital disorders. It was originally thought to be due to fibrosis of one the eye muscles, today we know it is due lack of development of the nucleus (control center in the brain) of the sixth nerve. Interestingly, most of these patients do not have diplopia (double vision) on lateral gaze.

Surgery should not be performed unless there is a cosmetic problem when looking straight ahead. A simpler solution than surgery is special glasses with prism to eliminate the head turn. Some of these patients have secondary convergence problems, which are effectively treated by vision therapy.