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| ARTICLES |
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| Year : 1981 | Volume
: 29
| Issue : 2 | Page : 113-114 |
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Combined horizontal and vertical retraction syndrome
P Prakash, V Menon
Dr. R.P. Centre for Ophthalmic Sciences, A.I.I.M.S. New Delhi, India
Correspondence Address:
P Prakash
Dr. R.P. Centre for Ophthalmic Sciences, A.I.I.M.S. New Delhi
India
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 7327689 
How to cite this article:
Prakash P, Menon V. Combined horizontal and vertical retraction syndrome. Indian J Ophthalmol 1981;29:113-4 |
The Stilling--Turk-Duane retraction syndrome is one of the commonest manifestations of the so called Musculofacial-innervational anomalies. Since the early descriptions, many papers describing its varied picture have been published.[1],[2],[3],[4],[5] Relatively uncommon analogous conditions involving vertical muscles have also been described.[6],[7],[8]
This report describes a rare case of a combination of both vertical and horizontal retraction syndrome.
| Case report | |  |
A 21 years old male came with the complaints of limitation of movement of eyes with associated palpebral aperture changes since birth. There was no history of birth trauma. There was no abnormality detected on systemic examination. His vision was 6/6 B.E. with no significant refractive error. There was no diplopia. The anterior segment and fundus examination revealed no abnormality. There was pigmentation in temporal bulbar conjunctiva of right eye. Ocular movements revealed interesting findings. [Figure - 1] In primary position the eyes showed minimal exophoria. Right eye on adduction showed retraction and narrowing of palpebral aperture and some amount of limitation of movement. There was gross limitation of abduction and the eye hardly moved away from primary position but showed slight hyperdeviation. The right eye also showed limitation of depression associated with retraction in dextro depression. Elevation was minimally affected. The lid of right eye did not follow the down ward movement of the right eye in primary position but on laevo and dextrodepression showed some downward movement of the lid.
Left eye had marked limitation of both adduction and abduction with slight widening of palbebral aperture on attempted abduction but no change in palpebral aperture on attempted adduction. The elevation of this eye was markedly restricted and on downward gaze it showed retraction of left globe. The left eye lid also did not show normal down ward movement and remained slightly retracted.
There was normal binocular vision in primary position but no diplopia. Charting on hess screening was not possible due to supression in secondary and tertiary positions of gaze.
Forced duction test revealed limitation of abduction and depression in RIE and limitation of elevation, adduction and abduction in left eye.
| Discussion | | |
This case presented very unique and interesting features of involvement of both eyes with regard to limitation of movements and associated retraction movements. The right eye showed marked retraction with narrowing of palpebral aperture and marked limitation of abduction movement and slight limitation of adduction movement depicting a typical Duane's retraction syndrome (Type `A') This eye also showed limitation of depression associated with retraction of eye ball on downward movement (vertical retraction). However it showed, an unusual feature of retraction of right upperlid on attempted depression showing an abnormal innervation of this lid which appears paradoxical. The paradoxical innervation in cases of Duane's retraction syndrome with regard to the extraocular muscle has already been amply demonstrated by many authors [9],[10],[11],[12],[13] This case however illustrates this phenomenon in lid movement also.
The left eye is practically fixed in horizontal movements showing limitations of both active and passive movements in adduction, abduction and elevation, associated with retraction of eye ball on depression (Vertical retraction). This also shows abnormal lid movements on down gaze though to a lesser extent than right eye.
In vertical retraction syndrome there is limitation of upward and downward movements with possible orthophoria in primary position. The superior rectus is usually more affected than inferior resulting in retraction on depression which is seen very well in left eye of this case. But in right eye the depression is more affected than elevation, still retraction is seen on dextro depression which is possible to explain on paradoxical innervation only.
As a whole the case presents itself as a mixture of horizontal retraction syndrome with bilateral vertical retraction syndrome associated with paradoxical lid movements. The presence of passive limitation of movements shows it to be of peripheral origin but the presence of vertical retraction on depression with greater limitation of depression van elevation and associated paradoxical movements of lid shows this case to be having dual genesis of innervational anomalies and peripheral anomalies.
| Summary | | |
A rare case of a combination of horizontal and vertical retraction syndrome associated with paradoxical lid movements has been presented.
| References | | |
| 1. | Sood, N.N., Dayal, Y; Agarwal, L.P. and Singh, P., 1971, Orient Arch. Ophthalmol 9:281.  |
| 2. | Pfaffenback, DD., Gross, H.H. and Kearres T.P., 1972, Arch. Ophthalmol, 88:635. |
| 3. | Goel, B.S. and Ahuja, L., 1976, East. Arch. Ophthalmol 4:158. |
| 4. | Isenberg. S. and Urist, H.J., 1977, Amer. J. Ophthalmol 84:429. |
| 5. | Prakash, P., 1978, East Arch. Ophthalmol 6:189, |
| 6. | Brown, 1950, Strabismus Ophthalmic Symposium I (ED. Allen) ST, Lewis, P. 250. |
| 7. | Scassellati-Sforzolini, 1958, Riv. Otoneuroflat 33:431. |
| 8. | Khoududoust and Von Norrden; 1967, Arch. Ophthalmol 78:606. |
| 9. | Papst and Esslen, 1960, Klin Mbl. Augenheilk S.C. 137:306. |
| 10. | Sato, S, 1960, Jap. J. Ophthalmol 4:57. |
| 11. | Blodi, F.C., Van Allen M.W: Yarbrough, J.C. 1964, Arch. Ophthalmol 72:171 |
| 12. | Huber, A. and Esslen, E., 1969, Docum Ophthalmol 26:619. |
| 13. | Prakash. P, 1978, East Arch. Ophthalmol 6:78. |
[Figure - 1]
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