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    By John D. Ferris, FRCOphth
    Squint Clinic
    Pediatric Ophth/Strabismus, Strabismus

    Most children with Duane’s Syndrome do not require glasses, patching or surgery. However, they will still be reviewed periodically in the clinic to make sure they are continuing to develop good vision in both eyes and good stereopsis.

    Occasionally surgery may be needed for the following reasons:

    • If there is a large strabismus when the child is looking straight ahead, which they cannot control by adopting a compensatory head posture.
    • If the child is getting neck problems as a result of this compensatory head posture.
    • If there is a marked up or down shoot of the affected eye.

    No form of surgery is likely to significantly improve the outward movement of the affected eye.

    Surgery normally involves weakening one or both of the medial rectus muscles. If there are marked up or down shoots the lateral rectus can also be set further back on the eyeball to limit the effects of its abnormal contraction when the child looks inwards.

    As with other types of surgery the most common complications of surgery are both over and under correction.

    • In the vast majority of Duane’s syndrome cases it is unwise to strengthen the lateral rectus muscle, as is frequently done for other types of convergent strabismus, because this often makes the retraction of the eyeball even more obvious and can result in a divergent strabismus.
    • Occasionally surgery can actually induce double vision or make pre-existing double vision worse.

    Republished, with permission, from www.squintclinic.com.