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Answers: 2007 series -  November 13, 2007 Lecture 7 of 52  NEXT»

To see views enlarged, click on the individual pictures...

This 13-year-old male is sitting in the waiting room as you walk into the examination area.  You will be seeing him during the course of the morning clinic.  He is reading a sign on the opposite wall.  While doing this he appears as shown in the picture.

1.  If you had only one guess as to the diagnosis, what would be your first choice?   
 

d -- Duane I, left eye

In an otherwise healthy looking boy as this picture shows with a moderate face turn, the most likely diagnosis is Duane syndrome class I.  Look up Ciancia syndrome on the Cyber-Sight web site and decide for yourself why this is not as likely a diagnosis. A neck muscle problem causing a face turn is possible, but is much rarer.

 

2.  The boy enters the examination room twenty minutes later.  What is the first thing you would do to arrive at the diagnosis as quickly as possible?  
 

b -- ask the boy to look to his left and then the far right

As you can see in the pictures below, when the boy looks to his left there is limited abduction consistent with reduced function of the left lateral rectus.  When he looks to the right, you see narrowing of the left palpebral fissure and enophthalmos, confirming the diagnosis of Duane I involving the left eye.


 

3.  How would you answer the mother who asks if this condition is likely to require surgery?
 

c -- Yes; surgery is likely.

It is likely that this boy would need surgery; that is, if the boy and the parents wanted it.  The boy has 20/20 vision in each eye and has stereopsis to 40 sec. of arc (normal).  He does see double when he looks to the left, but he can avoid this.  Even if surgery is done, you should tell the family that surgery for Duane can change the motility; hopefully for the better, but you cannot cure Duane. In addition even with successful surgery, which in this case would likely be a recession of the left medial rectus, as the boy grows older he is likely to have some problems in that Duane syndrome tends to become more symptomatic with age.
 

 

 


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