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ARTICLES |
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Year : 1972 | Volume
: 20
| Issue : 4 | Page : 185-186 |
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Duane's retraction syndrome associated with congenital ptosis
DK Sen, Harimohan
Department of Ophthalmology, Irwin Hospital, New Delhi, India
Correspondence Address: D K Sen Department of Ophthalmology, Irwin Hospital, New Delhi India
Source of Support: None, Conflict of Interest: None | Check |
PMID: 4671313
How to cite this article: Sen D K, Harimohan. Duane's retraction syndrome associated with congenital ptosis. Indian J Ophthalmol 1972;20:185-6 |
Duane's retraction syndrome is not seen to be associated with congenital ptosis. AGARWAL, DAYAL AND GUPTA [1] 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.
Case Report
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 [8] and DUKE-ELDER [7] considered that the lesion was at the highest level in the central nervous system while BIELCHOWSKY [5] and BANDER [4] 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 [3] 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, [2] MAYOU [10] ) MAYOU [10] 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,[9] DODDS[6]).
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 | | |
1. | Agarwal, L. P., Dayal, Y. and Gupta, A. K.: Marcus Gunn's associated with Duane's Retraction Syndrome. Orient, Arch. Ophthal, 1, 224 (1963). |
2. | Axenfeld and Schurenberg: Klin. Monats 64, 844, 861 (1901), cited in 7. |
3. | Bahr: Heidel, Bul.: 25, 334, (1896), cited in 7. |
4. | Bander, Arch of Ophth. (Chicago) 15, 21, (1936), cited in 7. |
5. | Bielchowsky, G. S.: (1932), cited in 7. |
6. | Dodds, L. G.: Congenital Muscular Squint. Brit. J. Ophthal. 10, 649, (1926), cited in 7. |
7. | Duke-Elder, S. Text-book of ophthalmology, Vol. 4, Henry Kimpton, London, (1952). |
8. | Fuchs, E. Bert. (1895). cited in 7. |
9. | Lagleyze: Due Strabisme, Paris, (1913), cited in 7. |
10. | 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]
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