Journal of Clinical and Experimental Ophthalmology
Open Access

Abstract

Case Series: Botulinum Toxin in the Management of Duane Retraction Syndrome type I

Abdulaziz A Al Taisan and Adi M Al Owaifeer

Introduction: Duane retraction syndrome (DRS) is a form of congenital strabismus related to impairment of extraocular muscle innervation. The condition was first described by Mr. Duane as "the absence or limitation of abduction with narrowing of palpebral fissure in adduction and globe retraction". DRS is thought to be caused primarily by agenesis of the sixth nerve nucleus, leading to fibrosis of the lateral rectus muscle. Horizontal rectus muscle recession is still considered the preferable surgical intervention. Indications include large deviation in primary position, abnormal head position or significant upshoot or downshoot. The rule of botox in DRS is still not fully understood. In this short series we aim to explore the efficacy of botulinum toxin as an alternative to surgical intervention in patients with DRS type 1.
Cases: The series include four patients of DRS type 1. Three patients underwent botox injection as a primary mode of treatment and one patient had a history of strabismus surgery two years prior to botox injection. Two patients maintained orthophoria over a follow-up period of 24 months; one patient didn't benefit from botox injection with similar angle of deviation pre and post injection. The fourth patient with history of strabismus surgery responded with reduction of the angle of deviation in the first and second visits, with return to the pre-injection angle on the sixmonth follow-up visit.
Conclusion: Botulinum toxin can serve as an alternative to surgery in DRS type I especially in young age groups where surgical intervention is not preferable. Further large-scale studies are needed to evaluate its use in other types of the syndrome and to explore its long-term effect.