Duane Retraction Syndrome: A Report of Two Cases and Review of Literature

Stilling-Duane syndrome, a congenital condition characterized by aberrant innervation of the lateral rectus muscle and agenesis of the abducent nerve or its nucleus, results in limited horizontal eye movements. It is often misdiagnosed as acquired abducent nerve paralysis. This report highlights the importance of considering Stilling-Duane syndrome in differential diagnoses. Case 1 is a 26-year-old female who presented to the Ophthalmology Clinic with recurrent ocular pain and puffiness over one month. She reported discomfort in both eyes, redness, and eyelid swelling but denied double vision or any significant medical history. Examination revealed normal visual acuity, marked restriction of abduction in the left eye, and asymmetry in palpebral fissure height during adduction. Horizontal nystagmus was noted at extreme abduction of the right eye. Case 2 is a 12-year-old female presented to the Ophthalmology Clinic with decreased vision in the left eye. Examination revealed decreased visual acuity in the left eye, marked restriction of abduction in the left eye, and asymmetry in palpebral fissure height during adduction. Given our patients' diagnosis of Duane retraction syndrome (DRS) type 1 with normal head posture, a management plan of observation was recommended. Surgical intervention may be considered in the future if significant changes such as abnormal head position or strabismus occur. This case emphasizes the need for careful evaluation of congenital eye movement disorders to avoid misdiagnosis and ensure appropriate management.