Indian Journal of Ophthalmology

ARTICLES
Year
: 1972  |  Volume : 20  |  Issue : 4  |  Page : 185--186

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




How to cite this article:
Sen D K, Harimohan. Duane's retraction syndrome associated with congenital ptosis.Indian J Ophthalmol 1972;20:185-186


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 ];20:185-186
Available from: https://www.ijo.in/text.asp?1972/20/4/185/34638


Full Text

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

1Agarwal, L. P., Dayal, Y. and Gupta, A. K.: Marcus Gunn's asso­ciated with Duane's Retraction Syn­drome. Orient, Arch. Ophthal, 1, 224 (1963).
2Axenfeld and Schurenberg: Klin. Monats 64, 844, 861 (1901), cited in 7.
3Bahr: Heidel, Bul.: 25, 334, (1896), cited in 7.
4Bander, Arch of Ophth. (Chicago) 15, 21, (1936), cited in 7.
5Bielchowsky, G. S.: (1932), cited in 7.
6Dodds, L. G.: Congenital Muscular Squint. Brit. J. Ophthal. 10, 649, (1926), cited in 7.
7Duke-Elder, S. Text-book of oph­thalmology, Vol. 4, Henry Kimpton, London, (1952).
8Fuchs, E. Bert. (1895). cited in 7.
9Lagleyze: Due Strabisme, Paris, (1913), cited in 7.
10Mayou, M. S.: Presidential address and discussion on Squint. Trans. ophth. Soc. United Kingdom, 54, 3, (1934), cited in 7.