Type I Duane's Retraction Syndrome: Clinical Spectrum, Motility Profiles, and Individualized Management Outcomes — A Case Series of Six Patients from a Tertiary Eye Care Centre

Abstract

Background: Duane's retraction syndrome (DRS) is a congenital cranial dysinnervation disorder accounting for up to 4% of strabismus presentations. Type I DRS, the most prevalent subtype, is characterised by abduction limitation, globe retraction, and palpebral fissure narrowing on adduction. Misdiagnosis as acquired abducens palsy remains a clinical challenge.

Methods: Six consecutive patients with clinically diagnosed Type I DRS presenting to a South Indian tertiary eye care centre (January 2024–December 2025) underwent comprehensive ophthalmic evaluation including nine-gaze motility assessment, prism bar cover test, cycloplegic refraction, and standardised photographic documentation.

Findings: Five females and one male (age range 11–39 years) were included. Bilateral involvement was present in four patients. All six demonstrated the cardinal triad of Type I DRS. Adduction upshoot was present in four patients (66.7%). Primary position deviation included orthotropia (n=4), exotropia (n=1), and esotropia (n=1). Five patients were managed conservatively; one underwent medial rectus recession achieving orthotropia at three-month follow-up.

Interpretation: Most Type I DRS patients are managed conservatively. Surgery, reserved for primary position deviation and amblyopia, yields excellent functional and cosmetic outcomes without restoring motility.