Type 4 Duane syndrome

Schliesser, Joshua; Sprunger, Derek T.; Helveston, Eugene M.

doi:10.1016/j.jaapos.2016.05.012

Cited by 7 publications

(6 citation statements)

References 9 publications

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“…Wilcox and associates4 demonstrated using EMG the cocontraction of ipsilateral MR and lateral rectus on the involved side. The condition might be considered as a variant of Duane syndrome, and it is sometimes referred to as type 4 Duane syndrome6 or exotropic Duane syndrome with synergistic divergence 39 40…”

Section: Discussionmentioning

confidence: 99%

“…Schliesser and associates6 recently reported a summary of 19 patients with features of synergistic divergence that were pooled from e-consultation program of Cybersight. However, in our current study, we present the largest number of cases of synergistic divergence reported by a single investigator.…”

Section: Discussionmentioning

confidence: 99%

“…Wilcox and associates4 considered it a variant of Duane syndrome and demonstrated cocontraction of the ipsilateral medial and lateral recti, and the condition is sometimes referred to as type 4 Duane syndrome 6. Furthermore, Kim and Hwang reported bilateral oculomotor nerve hypoplasia and absence of the abducent nerve on the affected side in two patients with synergistic divergence suggesting an abnormality of innervation of extraocular muscles in those patients 7.…”

Section: Introductionmentioning

confidence: 99%

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Synergistic divergence: case series and literature review

Awadein

Zedan

2017

Br J Ophthalmol

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Synergistic divergence: case series and literature review

Awadein

Zedan

2017

Br J Ophthalmol

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“…Acquired Synergistic Divergence: Contrary to Current Literature.Current literature reports synergistic divergence as a rare, congenital ocular motility pattern associated with adduction palsy. Its mechanism has been likened to Duane's syndrome, and some suggest it be referred to as Duane's Type 4 (Gupta et al 2010;Schliesser et al 2016;Wilcox et al 1981;Khan et al 2016). There are no published reports of synergistic divergence as an acquired condition, making this case report seemingly the first of its kind.…”

mentioning

confidence: 88%

“…So far there have been no reports of acquired SD in published literature. A majority of papers are in favour of classing congenital SD as an atypical form of Duane's retraction syndrome (Gupta et al 2010;Schliesser et al 2016;Wilcox et al 1981;Khan et al 2016), with one electro-oculographic study concluding their two patients with SD demonstrated a close relationship to Duane's Retraction Syndrome (Cruysberg et al 1959). This case report suggests SD could also be acquired, but this may be even rarer than its congenital form.…”

Section: Aetiologymentioning

confidence: 99%

Acquired Synergistic Divergence: Contrary to Current Literature

Waters¹

2020

British and Irish Orthoptic Journal

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IntroductionSynergistic Divergence (SD) is a rare ocular motility disorder associated with congenital adduction palsy (Cruysberg et al. 1959;Mohan et al. 1998;Oystreck et al. 2009;Gupta et al. 2010) and manifests as unilateral divergence of the affected eye on attempted adduction, resulting in bilateral abduction and a "wall-eyed" appearance when looking to the contralateral side.The earliest report of congenital synergistic divergence is from 1950 (Worth C. and Chavasse F.B.); however, since this time there have been no reports of acquired cases, hence the conclusion in literature to date is that this is a purely congenital condition. The following case report will challenge this conclusion and prompt questions regarding the mechanisms behind acquired SD. Presentation, Investigation and ManagementAn 18-year-old female was referred from her community optometrist with a 2-3 year history of diplopia and her left eye turning outwards, which had been worsening in the last year. Medical history was uneventful, including only tonsillitis and traumatic forceps delivery at birth. Her mother reported the patient had asymmetric pupils, with the left always being bigger and more sluggish, for as long as she could remember. On referral to Manchester Royal Eye Hospital, ocular motility demonstrated a restriction of left adduction and depression, slight left ptosis and anisocoria. Cover test revealed an incomitant exotropia for near and distance with diplopia. Initial diagnosis was a decompensating exophoria; however, this was challenged due to the presence of a -2.5 underaction of the left inferior rectus and sluggish left. In the following 12 months, the restriction of left medial rectus increased to -2 and the initial inferior rectus underaction developed into a restriction with the addition of a -0.5 restriction of left superior rectus. An MRI scan was ordered in November 2013, and this revealed a third nerve schwannoma in the cavernous sinus. The patient was sent for genetic testing to rule out neurofibromatosis type 2 and schwannomatosis.The tests were reported as negative for these conditions. The orthoptic report explicitly stated no aberrant regeneration in 2014. The patient had nine botulinum toxin (BT) injections to the left lateral rectus between 2014 and 2017 to control her diplopia. In 2017, she had a left lateral rectus recession of 5 mm and transposition of the upper muscle border to lower edge of insertion and a left medial rectus resection of 6 mm on adjustable sutures. An inferior oblique transposition was attempted, but a significant torsion effect was observed; therefore, the muscle was returned to its original position. Ocular motility Waters, M. 2020. Acquired Synergistic Divergence: Contrary to Current Literature.Current literature reports synergistic divergence as a rare, congenital ocular motility pattern associated with adduction palsy. Its mechanism has been likened to Duane's syndrome, and some suggest it be referred to as Duane's Type 4 (Gupta et al. 2010;Schliesser et al. 2016;Wilcox et al. 1981;...

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Duane Syndrome: An Infant with Crossed Eyes

Ditta

2023

Fundamentals of Pediatric Neuro-Ophthalmology

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Type 4 Duane syndrome

Cited by 7 publications

References 9 publications

Synergistic divergence: case series and literature review

Synergistic divergence: case series and literature review

Acquired Synergistic Divergence: Contrary to Current Literature

Duane Syndrome: An Infant with Crossed Eyes

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