Surgical outcome in right eye type II exotropic and left eye type III orthotropic Duane retraction syndrome: A rare case report

Duane retraction syndrome (DRS) is a congenital eye movement anomaly characterized by variable horizontal duction deficits, usually accompanied by narrowing of the palpebral fissure, globe retraction, and shoots. A 25-year-old male presented with right eye (RE) exotropia with full abduction but limitation of adduction with a downshoot on attempted adduction. In the left eye (LE), there was a limitation of both adduction and abduction. We did lateral rectus (LR) recession and Y-splitting along with transposition of the nasal half of the superior rectus (SR) tendon adjacent to the medial rectus in the RE. Postoperatively, the eye was orthotropic with significant improvement in adduction and downshoot. In exotropic DRS with a downshoot in adduction, LR is usually tight. However, in our case, it was lax. We did LR recession with Y-split and got satisfactory results. Downshoot on attempted adduction is primarily due to an innervational anomaly. Partial tendon transposition of the SR tendon was performed to improve adduction. As LE was orthotropic, no surgical intervention was done. Lax LR should not change the surgical plan in DRS with shoots on adduction.