Dissociated vertical deviation in a patient with Duane's retraction syndrome

Dissociated vertical deviation is a not uncommon strabismic syndrome characterized by upward deviation of an eye when occluded, with downward movement of the eye when occlusion is removed. Associated findings include latent nystagmus and horizontal strabismus. Duane's retraction syndrome is the clinical declaration of anomalous cranial nerve innervation characterized by a marked limitation or absence of abduction, variable limitation of adduction, narrowing of the palpebral fissure, and apparent globe retraction on attempted adduction. We report a patient with both dissociated vertical deviation and bilateral Duane's retraction syndrome, demonstrating that dissociated vertical deviation can occur with the anomalous neuroanatomic substrate present in Duane's retraction syndrome.