Topic outline

  • Grand Rounds

    An adult patient was referred to our service for strabismus evaluation due to crossing of the eyes. Patient complained of having difficulty looking towards the right side, which had occurred since childhood. The patient also reported moderate to severe headaches, ocular pain in the left eye and neck pain. Past medical history and social history were irrelevant. Patient had no history of trauma or ocular surgery, and no family history of strabismus. On the ophthalmic exam, best corrected visual acuity was 20/20 in both eyes, intra-ocular pressure 10/13 mmHg, confrontation visual fields and color plates were normal, and anterior segment and dilated fundus exam were unremarkable. On sensorimotor examination, patient had severe limitation to abduction of the right eye and palpebral fissure narrowing with mild right globe retraction on adduction. In primary position, with the head straight, patient had an esotropia of 25 prism diopters, which increased to 75 in right gaze. Stereopsis was full (tested with abnormal head posture, right head turn). Based on clinical findings patient was diagnosed with esotropic Duane retraction syndrome of the right eye and surgery was recommended to improve ocular alignment and head posture. The surgery performed was a recession of the right medial rectus muscle on an adjustable suture and a right superior rectus muscle transposition to the right lateral rectus muscle with augmentation suture. Postoperatively patient had no diplopia, and the compensatory head posture was fully resolved. An excellent post operative ocular alignment and good appearance were achieved, with a small residual right esotropia of 4 prism diopters.

    Presentation Date: 10/12/2023
    Issue Date: 10/27/2023