Pseudo-Duane’s retraction syndrome: a rare clinical entity
Keywords:Medial orbital wall fracture, Pseudo-Duane’s retraction syndrome, Forced duction test
Studies of sequelae of isolated medial orbital wall fractures show that the majority of patients with this condition are often asymptomatic, which makes the diagnosis based only on clinical grounds difficult. One of the rare complications of this entity is Pseudo-Duane’s retraction syndrome, which is characterised by horizontal diplopia, restricted abduction with or without limited adduction, accompanied by narrowing of the palpebral fissure, globe retraction and pseudo ptosis on abduction. This is a case report of a 46-year-old female who developed Pseudo-Duane’s retraction syndrome following trauma to her left orbit. She presented with left eye pain, diplopia, horizontal gaze restrictions, left eye ecchymosis and enophthalmos. Careful history taking and thorough ophthalmic examination including forced duction test along with radiological imaging helped clinch this diagnosis. Timely intervention by an endoscopic approach to release the medial rectus muscle entrapped within the fracture resolved the patient’s symptoms.
Song WK, Lew H, Yoon JS, Oh MJ, Lee SY. Role of medial orbital wall morphologic properties in orbital blow-out fractures. Investigative Ophthalmol Visual Sci. 2009;50(2):495-9.
Gittinger JW, Jr, Hughes JP, Suran EL. Medial orbital wall blow-out fracture producing an acquired retraction syndrome. J Clin Neuroophthalmol. 1986;6:153-6.
Jordan DR, Allen LH, White J, Harvey J, Pashby R, Esmaeli B. Intervention within days for some orbital floor fractures: the white-eyed blowout. Ophthal Plast Reconstr Surg. 1998;14:379-90.
DeRespinis PA, Caputo AR, Wagner RS, Guo S. Duane's retraction syndrome. Surv Ophthalmol. 1993;38:257-88.
Kekunnaya R, Negalur M. Duane retraction syndrome: causes, effects and management strategies. Clin Ophthalmol. 2017;11:1917-30.
Warwar RE, Bullock JD, Ballal DR, Ballal RD. Mechanisms of orbital floor fractures: a clinical, experimental, and theoretical study. Ophthal Plast Reconstr Surg. 2000;16:188-200.
Nolasco FP, Mathog RH. Medial orbital wall fractures: classification and clinical profile. Otolarygol Head Neck Surg. 1995;112:549-56.
Brannan PA, Kersten RC, Kulwin DR. Isolated medial orbital wall fractures with medial rectus muscle incarceration. Ophthal Plast Reconstr Surg. 2006;22:178-83.
Duane TD, Schatz NJ, Caputo AR. Pseudo-Duane’s retraction syndrome. Trans Am Ophthalmol. 1976;74:122-9.
Murthy R. Inverse Duane's retraction syndrome following myocysticercosis. Indian J Ophthalmol. 2008;56(1):89-90.
Khan AO. Inverse globe retraction syndrome complicating recurrent pterygium. Br J Ophthalmol. 2005;89(5):640‐1.
Lew H, Lee JB, Kim HS, Han SH. A case of congenital inverse Duane's retraction syndrome. Yonsei Med J. 2000;41(1):155-8.
Chatterjee PK, Bhunia J, Bhattacharyya I. Bilateral inverse Duane’s retraction syndrome-a case report. Indian J Ophthalmol. 1991;39:183-5.