Duane's syndrome is due to some miswiring of the eye muscles. The "mistake" probably happens around the 6th week of pregnancy and is due to poor development of tiny parts of the brain stem that controls the eye muscles.

The main features of patients with Duane's syndrome are:

1. Decreased ability to move the affected eye outwards (towards the ear).
2. When the affected eye is moved towards the nose, the whole eyeball is gently pulled inwards (into the head!).
3. There may be some misalignment and decreased vision of the affected eye (strabismus and amblyopia).
4. There may be a face turn (especially when the child concentrates).
5. The child may have double vision. They never volunteer this - you have to actually ask.

Duane's syndrome is infrequently associated with hearing problems, neck problems and with cosmetic deformities of the eyelid or external ear or thumb.

Treatment in Duane's syndrome may be required for:

1. Decreased vision. The child may need glasses and/or occlusion.
2. Abnormal eye alignment. This may require glasses and/or surgery.
3. Face turn. A face turn can make a child look weird, and can also interfere with normal growth of the face and neck. An operation can make this better.
4. Restricted mobility of the eye.
5. Restricted field of vision.

Surgery for Duane's syndrome

Surgery cannot fix the problem of nerves that go the wrong way and wire up the eye muscles incorrectly. Surgery cannot make you normal, but surgery can (and usually does) substantially improve on your current situation. There are two main approaches to surgery:

1. Surgery to a muscle of the other eye changes the nerve supply to the affected eye.
2. We can create a "rubber band" effect by shifting some normal muscles around to take over the effect of the wrongly innervated muscles.

The full effect of the surgery may take some weeks to become apparent.

There is a low incidence of unexpected results - results that in some way make you worse than you were before the surgery (< 5%). If this happens to you, you may need to have the surgery reversed within a few weeks.


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