Strabismus pp 251-265 | Cite as

Duane Syndrome

  • Burton J. Kushner


Duane syndrome is the most common form of aberrant innervation . It is the result of a maldevelopment in which the sixth cranial nerve either does not form or forms only partially, resulting in absence or greatly diminished lateral rectus muscle (LR) recruitment on attempted abduction [1, 2]. In addition, branches of the third cranial nerve are redirected to aberrantly innervate the LR, resulting in anomalous recruitment of the LR, most typically, on attempted adduction. Generally, fibers destined for the medial rectus muscle (MR) get redirected to the LR. Depending on how many fibers normally destined for the MR get redirected in this manner, there may be essentially normal, somewhat subnormal, or markedly abnormal MR innervation and strength [3, 4]. The amount of aberrant innervation to the LR is, therefore, often inversely proportional to the amount of normal MR innervation. Duane syndrome, when isolated and not part of a syndrome, is sporadic about 90% of the time. Occasionally, it is familial. Duane syndrome is usually unilateral, but bilateral occurrence has been reported in between 10 and 20% of cases [5]. Based on some elegant work studying adults with thalidomide embryopathy, a population in which there is a high incidence of Duane syndrome, Miller determined that there is an early sensitive period at approximately days 21–26 after conception during which the insult resulted in Duane syndrome [6].


Downshoots Duane syndrome Posterior fixation Synergistic abduction Synergistic divergence Upshoots Vertical rectus transposition Y-splitting 


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© Springer International Publishing AG 2017

Authors and Affiliations

  • Burton J. Kushner
    • 1
  1. 1.Department of Ophthalmology and Visual SciencesUniversity of Wisconsin-MadisonMadisonUSA

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