From the Research
The primary management approach for Duane syndrome with fibrosis is surgical intervention, as it has been shown to improve alignment in primary position and reduce or eliminate abnormal head posture, with the most recent and highest quality study 1 supporting the use of botulinum toxin A injection as a diagnostic tool and treatment option in adults.
Key Considerations
- Surgery is typically recommended when patients have significant face turn (abnormal head positioning), notable strabismus in primary gaze, or severe globe retraction with narrowing of the palpebral fissure.
- The most common surgical procedures include recession of the lateral rectus muscle on the affected side, which helps reduce the co-contraction and subsequent globe retraction.
- In cases with significant upshoot or downshoot, Y-splitting of the lateral rectus muscle may be performed.
- For patients with severe limitation of abduction, a vertical rectus transposition procedure might be considered to improve the eye's outward movement.
Conservative Management
- Conservative management is appropriate for patients with mild symptoms, including observation and possibly prism glasses for small deviations.
- The timing of surgery is typically determined by the severity of symptoms, with intervention often delayed until the child is old enough for accurate measurements of deviation and assessment of head posture, usually around 4-5 years of age.
Recent Study Findings
- A recent study 1 found that botulinum toxin A injection can have a useful diagnostic role in adults with Duane retraction syndrome, providing insight to patients and setting realistic expectations, and also has a positive impact on quality of life.
- The study also found that botulinum toxin A injection can identify patients likely to benefit from further treatment and has a significant reduction in ocular deviation in esotropic and exotropic Duane retraction syndrome.