Lateral Rectus Disabling and Simultaneous Modified Nishida Procedure for Exotropic Duane Retraction Syndrome

ABSTRACT

Exotropic-Duane Syndrome (XT-DRS) is a congenital cranial nerve dysinnervation disorder characterized by exotropia, anomalous head posture (contralateral face turn), limited adduction, globe retraction, palpebral fissure narrowing, upshoot and downshoot in adduction, and varying levels of limitation of abduction. Patients with XT-DRS often have poor convergence because attempted convergence induces co-contraction of the lateral rectus muscle (LR) due to anomalous LR innervation. We describe two patients with XT-DRS who underwent simultaneous lateral rectus muscle (LR) disinsertion and periosteal fixation (LRDAPF) and modified Nishida procedure (MNP) and discuss their outcome. In one patient, we combined this procedure with a contralateral LR recession. Anomalous head posture, exotropia, globe retraction, and palpebral fissure narrowing were reduced. Upshoot and downshoot were also reduced. Convergence improved in both patients.

KEYWORDS:

• Duane retraction syndrome
• lateral rectus disinsertion and periosteal fixation
• modified Nishida procedure
• exotropia
• Y split recession
• palpebral fissure narrowing
• globe retraction

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/2576117X.2024.2375666.

Additional information

Funding

This work was supported in part by an unrestricted grant from Research to Prevent Blindness, Inc., to the UW-Madison Department of Ophthalmology and Visual Sciences (Dr. Kushner). We have not received any additional funding or sponsorship for the study.