Clinical Profile and Surgical Outcomes of Bilateral Duane Syndrome with Exotropia

To study the clinical profile and surgical outcomes of patients with bilateral Duane syndrome with exotropia.

The records of all consecutive patients diagnosed with bilateral Duane syndrome with exotropia in primary gaze (2010-2024) were reviewed. Patient demography, age at presentation, and type of Duane syndrome were studied in the clinical profile. The pre-operative and post-operative details of angle of deviation, abnormal head posture, horizontal ocular ductions, grade of globe retraction, and overshoot were evaluated for the surgical outcomes.

Forty-five patients (male, 51%) were diagnosed with bilateral Duane syndrome with exotropia, of which 38% underwent surgical correction. The mean age at presentation was 18.06 ± 12.08 years. Of the total, 37% were emmetropic and 29% amblyopic. Bilateral type 3 Duane syndrome (49%) was the most common presentation. The mean pre-operative deviation for distance and near was 29.84 ± 17.73Δ and 32.49 ± 18.44Δ, respectively. The mean change in angle of deviation post-operatively for distance and near was 23 ± 5Δ and 26 ± 5Δ, respectively. The average angle of deviation at the final follow-up for distance was 8 ± 12Δ and near 12 ± 12Δ. Surgical success for primary position deviation, abnormal head posture, globe retractions, and overshoots was achieved in 59%, 86%, 57%, and 50% patients, respectively.

Bilateral type 3 is the most common bilateral Duane syndrome with exotropia. Individualized surgical management (algorithm) ensures optimal alignment and head posture correction.