Lateral rectus muscle recession for intermittent exotropia with anomalous head position in type 1 Duane’s retraction syndrome

  • Ju-Yeun Lee
  • Kyung-Ah Park
  • Sei Yeul OhEmail author



We questioned how to treat for intermittent exotropia in type 1 Duane’s retraction syndrome (DRS). To avoid secondary abduction deficit and late overcorrection on the affected eye following ipsilateral lateral rectus (LR) recession, we performed less correction of the lateral rectus (LR) recession to correct exodeviation and anomalous head position (AHP). We report the surgical outcomes of LR recession in patients with unilateral type 1 DRS.


Four patients who underwent less correction of LR recession in the affected eye to correct intermittent exotropia and AHP to the contralateral side in type 1 DRS were enrolled. Data on preoperative and postoperative angle of exodeviation, degree of AHP, ocular motility, global retraction, palpebral fissure change, and complications were retrospectively obtained. Success was defined as postoperative deviation within 8 prism diopters (PD) and AHP < 5°.


The preoperative angles of exodeviation and AHP were significantly improved after LR recession. The median grade of abduction limitation was improved from − 1.3 to − 0.8 postoperatively. Final median value of deviation was orthotropia in the primary position of the eye with the normal motility. All patients had successful outcomes without overcorrection or further abduction limitation in DRS eyes.


Less correction of ipsilateral LR recession may be useful for correcting intermittent exotropia and AHP in patients with type 1 DRS.


Duane retraction syndrome Intermittent exotropia Lateral rectus recession Modified grading 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Institutional Review Board of Samsung Medical Center. All procedures performed in this study were in accordance with the ethical standards of Samsung Medical Center and followed the tenets of the Declaration of Helsinki.

Informed consent

For this type of study, formal consent is not required.


  1. 1.
    Huber A (1974) Electrophysiology of the retraction syndromes. Br J Ophthalmol 58:293–300CrossRefGoogle Scholar
  2. 2.
    O'Malley ER, Helveston EM, Ellis FD (1982) Duane’s retraction syndrome -- plus. J Pediatr Ophthalmol Strabismus 19:161–165PubMedGoogle Scholar
  3. 3.
    Raab EL (1986) Clinical features of Duane’s syndrome. J Pediatr Ophthalmol Strabismus 23:64–68PubMedGoogle Scholar
  4. 4.
    Kekunnaya R, Gupta A, Sachdeva V (2012) Duane retraction syndrome: series of 441 cases. J Pediatr Ophthalmol Strabismus 49:164–169CrossRefGoogle Scholar
  5. 5.
    Tibrewal S, Sachdeva V, Ali MH, Kekunnaya R (2015) Comparison of augmented superior rectus transposition with medial rectus recession for surgical management of esotropic Duane retraction syndrome. J AAPOS 19:199–205CrossRefGoogle Scholar
  6. 6.
    Pressman SH, Scott WE (1986) Surgical treatment of Duane’s syndrome. Ophthalmology 93:29–38CrossRefGoogle Scholar
  7. 7.
    Farvardin M, Rad AH, Ashrafzadeh A (2009) Results of bilateral medial rectus muscle recession in unilateral esotropic Duane syndrome. J AAPOS 13:339–342CrossRefGoogle Scholar
  8. 8.
    Molarte AB, Rosenbaum AL (1990) Vertical rectus muscle transposition surgery for Duane’s syndrome. J Pediatr Ophthalmol Strabismus 27:171–177PubMedGoogle Scholar
  9. 9.
    Velez FG, Foster RS, Rosenbaum AL (2001) Vertical rectus muscle augmented transposition in Duane syndrome. J AAPOS 5:105–113CrossRefGoogle Scholar
  10. 10.
    Jampolsky A (1986) Strategies in strabismus surgery. In: Metz HS (ed) Pediatric ophthalmology and strabismus: transactions of the New Orleans Academy of Ophthalmology. Raven, New York, pp 366–367Google Scholar
  11. 11.
    Dotan G, Klein A, Ela-Dalman N, Shulman S, Stolovitch C (2012) The efficacy of asymmetric bilateral medial rectus muscle recession surgery in unilateral, esotropic, type 1 Duane syndrome. J AAPOS 16:543–547CrossRefGoogle Scholar
  12. 12.
    Ansons AM, Davies H (2001) Diagnosis and management of ocular motility disorders (3rd ed.). Blackwell Science, London, pp 104–105Google Scholar
  13. 13.
    Kushner BJ (2000) The usefulness of the cervical range of motion device in the ocular motility examination. Arch Ophthalmol 118:946–950PubMedGoogle Scholar
  14. 14.
    Kestenbaum A (1961) Clinical methods of neuro-ophthalmological examinations, 2nd edn. Grune & Stratton, New York and LondonGoogle Scholar
  15. 15.
    Holmes JM, Hohberger GG, Leske DA (2001) Photographic and clinical techniques for the outcome assessment in sixth nerve palsy. Ophthalmology 108:1300–1307CrossRefGoogle Scholar
  16. 16.
    Lee JY, Lee GI, Park KA, Oh SY (2017) Long-term evaluation of two reoperation groups for intermittent exotropia. J AAPOS 21:349–353CrossRefGoogle Scholar
  17. 17.
    Akar S, Gokyigit B, Pekel G, Demircan A, Demirok A (2013) Vertical muscle transposition augmented with lateral fixation (Foster) suture for Duane syndrome and sixth nerve palsy. Eye (Lond) 27:1188–1195CrossRefGoogle Scholar
  18. 18.
    Kraft SP, O’Donoghue EP, Roarty JD (1992) Improvement of compensatory head postures after strabismus surgery. Ophthalmology 99:1301–1308CrossRefGoogle Scholar
  19. 19.
    Mazzei V, Nasso G, Anselmi A, Salamone G, Mangano S, Grassi R (2006) Correction of discrete subaortic stenosis with abnormal chordae tendineae. J Card Surg 21:271–273CrossRefGoogle Scholar
  20. 20.
    Farid MF (2016) Y-split recession vs isolated recession of the lateral rectus muscle in the treatment of vertical shooting in exotropic Duane retraction syndrome. Eur J Ophthalmol 26:523–528CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Ophthalmology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea

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