Indian Journal of Ophthalmology

: 1984  |  Volume : 32  |  Issue : 4  |  Page : 243--244

Bilateral Duane's retraction syndrome associated with crocodile tears

Rajendra Kumar Agarwal 
 82, Ahilyapura, Indore, India

Correspondence Address:
Rajendra Kumar Agarwal
82, Ahilyapura

How to cite this article:
Agarwal RK. Bilateral Duane's retraction syndrome associated with crocodile tears.Indian J Ophthalmol 1984;32:243-244

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Agarwal RK. Bilateral Duane's retraction syndrome associated with crocodile tears. Indian J Ophthalmol [serial online] 1984 [cited 2023 May 30 ];32:243-244
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The occasional association of various cen�tral nervous anamalies with Duane's retrac�tion syndrome have been reported. A combination of Duane's and Crocodile tears is very rare [1],[2]. This report describes a case of combination of Duane's with Crocodile tears syndrome.

 Case Report

N, 15 yrs. male was admitted with the complaints of watering from both eyes while eating and inability to turn both eyes out. This watering from both eyes was first noted by mother since his early childhood life while inability to abduct both eyes was noted in infancy. The patient had experienced much discomfort due to watering. His mental development and physical growth were nor�mal. No history of any other systemic abnor�mility was present. There was no history. of birth trauma too. No other family member is having such discomfort. Eye examination [Figure 1] There was no ocular abnormality, except res�trction of ocular movements. Both eyes could not be abducted beyond midline. The other ocular movements were normal. There was narrowing of palpebral fissure with retraction of the globe of right eye on levoversion [Figure l][Figure 2] and likewise left eye was also observed on dextroversion [Figure 3].

Lacrimal sac syringing revealed no obst�ruction in lacrimal passages. X-ray exami�nation of skull bone, chest and vertebrae were normal.

Investigative procedure [Figure 4]

1. He was given a packet of biscuits to eat. With each movement of mastication both eyes became increasingly moist.

2. The sugar was applied directy to various areas of tongue without sucking movement. This stimulii resulted in a barely perceptible tearing of both eyes.


The etiology of Duane's syndrome itself is complex but its etiological concept embraces the idea of supranuclear paradoxic inerva�tion, presumably within brain stem, leading to a contraction of medial rectus and lateral rectus which suggest an aberrant innervation of lateral rectus or of VI nerve from III nerve fibres. The neurogenic theory has been further supported by association of Duane's with central nervous anamalies of which most common is Klippe fell anamaly, congenital labyrinthine deafness, Marcus Gun phene�monon, and paradoxical gustatory lacrimal reflex[1],[2],3. This paradoxical gustatory lac�rimal reflex may be congenital or acquired in nature. In acquired type, the most accepted theory is the abnormal regeneration of salivary nerve fibres of VII nerve with the onset or sequelae of seventh nerve palsy. Thus patients lacrimate whenever a gustatory stimulus producing salivation is evoked. But this theory is not tenable in congenital variety of gustato lacrimal reflex.

The various authors have proposed that an abnormal process is responsible for a failure of differentiation of lacrimal and salivary nuclei resulting in congenital paradoxical gustato-lacrimal reflex or nuclear connection in VI nerve in pons gives rise to the Duane's syndrome 4,5. Probably in present patient also this abnormal process is responsible for bilateral Duane's and Crocodile tear syndrome.

Regarding surgical management of this condition, most authors do not recommend any type of surgery. In Duane's. surgery in the form bilateral medial rectus recession, is per�formed while for reliving of severe crocodile tear symtoms transtympanic surgial section of glossopharyngeal nerve may he tried if patient is having discomfort due to croco�dile tear.


A rare case of bilateral Duane's syndrome with congenital paradoxical gustatory reflex (Crocodile tear syndrome) is reported.


1Regenbogen. L. and Suein. R.. 1968, Ophthal�molpegica 156:353.
2Brik. M. and Athayde, A., 1973. Ophthalmologica 167:1.