|Year : 1972 | Volume
| Issue : 4 | Page : 185-186
Duane's retraction syndrome associated with congenital ptosis
DK Sen, Harimohan
Department of Ophthalmology, Irwin Hospital, New Delhi, India
D K Sen
Department of Ophthalmology, Irwin Hospital, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sen D K, Harimohan. Duane's retraction syndrome associated with congenital ptosis. Indian J Ophthalmol 1972;20:185-6
|How to cite this URL:|
Sen D K, Harimohan. Duane's retraction syndrome associated with congenital ptosis. Indian J Ophthalmol [serial online] 1972 [cited 2021 Apr 11];20:185-6. Available from: https://www.ijo.in/text.asp?1972/20/4/185/34638
Duane's retraction syndrome is not seen to be associated with congenital ptosis. AGARWAL, DAYAL AND GUPTA  reported one case where the syndrome was in association with congenital ptosis which retracted on opening the mouth. Another such association is reported here. Opening of mouth or any other extra-ocular stimulus, however, had no effect on the ptosed lid in the present case.
A 7-year-old Hindu female reported to the hospital with the complaints of drooping of the right upper lid present since birth. There was nothing unusual in the birth history. No other member in the family was afflicted with similar defect. On examination: Visual acuity (Snellen's Chart), R.E. 6/6, L.E. 6/9, while looking straight ahead, partial ptosis on the right side but no squint, left dye 10° hypertropic [Figure - 1]. Dextroversion showed widening of right palpebral aperture with Protrusion of the globe and moderate limitation of movement and increased hypertropia on the left side [Figure - 2]. Laevo-version showed full range of movement, retraction of the globe and narrowing of the palpebral aperture on the right side. On slight depression of eyes during laevoversion there was marked down drift of the right globe [Figure - 3]. Passive movements of adduction and abduction elicited under general anaesthesia by means of forceps were normal.
| Discussion|| |
Etiopathogenesis of Duane's retraction syndrome is not fully known. Different explanations have been offered by different workers from time to time and opinion is still divided about its being central or a peripheral lesion. FUCHS  and DUKE-ELDER  considered that the lesion was at the highest level in the central nervous system while BIELCHOWSKY  and BANDER  thought it to be a peripheral one. Of late it is being increasingly felt that all the cases do not have the same etiology.
BAHR  observed the medial rectus to be inserted in two portions, one 12 mm. behind the limbus and the other still further behind. This abnormal posterior insertion of medial rectus would act as a retractor bulbi (AxENFELD AND SCHURENBERG,  MAYOU  ) MAYOU  also demonstarted that there was increase in fibrous tissue in the lateral rectus which might have been a developmental anomaly on the result of haemorrhage in the muscle fibres or rupture of its sheath. In other cases, both recti have been found at operation to be normal and to be normally inserted (LAGLEYZE, DODDS).
In the present case in view of the full range of passive movements under general anaesthesia we feel that the anomaly is due to congenital anomalous nervous connections at the higher level.
The present case is interesting because of the presence of congenital ptosis on the affected side and presence of hypertropia on the contralateral side which was more marked on looking towards the affected side.
| Summary|| |
An atypical case of Duane's retraction syndrome affecting the right side associated with congenital ptosis on the same side and hypertropia on the contralateral side is reported.
| References|| |
Agarwal, L. P., Dayal, Y. and Gupta, A. K.: Marcus Gunn's associated with Duane's Retraction Syndrome. Orient, Arch. Ophthal, 1, 224 (1963).
Axenfeld and Schurenberg: Klin. Monats 64, 844, 861 (1901), cited in 7.
Bahr: Heidel, Bul.: 25, 334, (1896), cited in 7.
Bander, Arch of Ophth. (Chicago) 15, 21, (1936), cited in 7.
Bielchowsky, G. S.: (1932), cited in 7.
Dodds, L. G.: Congenital Muscular Squint. Brit. J. Ophthal. 10, 649, (1926), cited in 7.
Duke-Elder, S. Text-book of ophthalmology, Vol. 4, Henry Kimpton, London, (1952).
Fuchs, E. Bert. (1895). cited in 7.
Lagleyze: Due Strabisme, Paris, (1913), cited in 7.
Mayou, M. S.: Presidential address and discussion on Squint. Trans. ophth. Soc. United Kingdom, 54, 3, (1934), cited in 7.
[Figure - 1], [Figure - 2], [Figure - 3]