Unilateral Duane Retraction Syndrome Associated With Crocodile Tears: a Case Study

1. Shao-Chun Chen¹
2. Chun-Chen Chen¹
3. Shiow-Wen Liou^1,2,3

¹Department of Ophthalmology, Taipei City Hospital, RenAi Branch, Taiwan
²College of medicine, Taipei medical university, Taiwan
³College of medicine, National Taiwan university, Taiwan

Purpose: To report an unusual case of unilateral Duane retraction syndrome associated with crocodile tears.

Methods: A 21 year-old Taiwanese lady presented with partial abduction and adduction deficiency of the right eye. Shortly after birth, the parents had noted that eating was accompanied by profuse lacrimation from right eye. There was no relevant trauma, surgery, orbital inflammation, or family history of strabismus.

Results: On examination, the best corrected visual acuity was 20/25 on both eyes. The external eye examination revealed enophthalmos of the right globe (4 mm relative to the left eye). Fundus examination showed no specific abnormal finding. In primary position, head posture had tilted to right side. When looking to the left side, pseudoptosis of the right eye was observed. There was no upshoot or downshoot observed. Forced duction test showed limited passive movement of the right lateral rectus muscle and normal passive movement of the right medial rectus muscle. Decreased reflex tearing (OU) was noted by Schirmer's test. General examination revealed normal emotional facial movements. Her mental development and physical growth were normal.

Conclusions: This case demonstrated the Duane syndrome is characterized by congenital horizontal ophthalmoplegia primarily affecting the abducens nucleus. In addition, the globe retracts into the orbit, accompanied by narrowing of the palpebral fissure. The phenomenon of non-emotional tearing during eating (crocodile tears) was related to paradoxical gustolacrimal reflex. Here, we reported a rare case of Duane restriction syndrome combined with crocodile tears.