About Duane Syndrome

Duane syndrome (DS) is a miswiring of the eye muscles, causing some eye muscles to contract when they shouldn't and other eye muscles not to contract when they should. People with DS have a limited (and sometimes absent) ability to move the eye outward toward the ear (abduction) and, in most cases, a limited ability to move the eye inward toward the nose (adduction).

Often, when the eye moves toward the nose, the eyeball also pulls into the socket (retraction), the eye opening narrows and, in some cases, the eye will move upward or downward. Many patients with DS develop a face turn to maintain binocular vision and compensate for improper turning of the eyes.

In about 80 percent of cases of DS, only one eye is affected, most often the left. However, in some cases, both eyes are affected, with one eye usually more affected than the other.

Other names for this condition include: Duane's Retraction Syndrome (or DR syndrome), Eye Retraction Syndrome, Retraction Syndrome, Congenital retraction syndrome and Stilling-Turk-Duane Syndrome.

In 70 percent of DS cases, this is the only disorder the individual has. However, other conditions and syndromes have been found in association with DS. These include malformation of the skeleton, ears, eyes, kidneys and nervous system, as well as:

• Okihiro's syndrome, an association of DS with forearm malformation and hearing loss,

• Wildervanck syndrome, fusion of neck vertebrae and hearing loss,

• Holt-Oram syndrome, abnormalities of the upper limbs and heart,

• Morning Glory syndrome, abnormalities of the optic disc or "blind spot", and

• Goldenhar syndrome, malformation of the jaw, cheek and ear, usually on one side of the face.

Clinically, Duane syndrome is often subdivided into three types, each with associated symptoms.

• Type 1: The affected eye, or eyes, has limited ability to move outward toward the ear, but the ability to move inward toward the nose is normal or nearly so. The eye opening narrows and the eyeball pulls in when looking inward toward the nose, however the reverse occurs when looking outward toward the ear. About 78 percent of all DS cases are Type 1.

• Type 2: The affected eye, or eyes, has limited ability to move inward toward the nose, but the ability to move outward toward the ear is normal or nearly so. The eye opening narrows and the eyeball pulls in when looking inward toward the nose. About 7 percent of all DS cases are Type 2.

• Type 3: The affected eye, or eyes, has limited ability to move both inward toward the nose and outward toward the ears. The eye opening narrows and the eyeball pulls in when looking inward toward the nose. About 15 percent of all DS cases are Type 3.

Each of these three types can be further classified into three subgroups, depending on where the eyes are when the individual looks straight (the primary gaze):

• Subgroup A: The affected eye is turned inward toward the nose (esotropia).

• Subgroup B: The affected eye is turned outward toward the ear (exotropia).

• Subgroup C: The eyes are in a straight, primary position.

Common thought is that Duane syndrome (DS) is a miswiring of the medial and the lateral rectus muscles, the muscles that move the eyes. Also, patients with DS lack the abducens nerve, the sixth cranial nerve, which is involved in eye movement. However, the etiology or origin of these malfunctions is, at present, a mystery.

Many researchers believe that DS results from a disturbance - either by genetic or environmental factors - during embryonic development. Since the cranial nerves and ocular muscles are developing between the third and eighth week of pregnancy, this is most likely when the disturbance happens.

Presently, it appears that several factors may be involved in causing DS. Therefore it is doubtful that a single mechanism is responsible for this condition.

The diagnosis of Duane syndrome is based on clinical findings. Mutations in the CHN1 gene are associated with familial isolated Duane syndrome. Direct sequencing of the CHN1 gene is available as a clinical test, and has to date detected missense mutations in seven patients and affected family members. The CHN1 mutations have not been found to be a common cause of simplex Duane retraction syndrome.

Most likely, both genetic and environmental factors play a role in the development of Duane syndrome (DS). For those cases that show evidence of having a genetic cause, both dominant and recessive forms of DS have been found. (When a gene is dominant, only one gene from one parent is needed for the individual to express it physically. However, when a gene is recessive, a copy of the gene from both parents is needed for expression.)

The chromosomal location of the proposed gene for this syndrome is currently unknown. Some research shows that more than one gene may be involved. There is evidence that a gene involved in the development of DS is located on chromosome 2. Also, deletions of chromosomal material from chromosomes 4 and 8, as well as the presence of an extra marker chromosome thought to be derived from chromosome 22, have been linked to DS.

Additional Resources for Duane Syndrome

• GeneReviews

• Boston Children's Hospital

• MUMS National Parent-to-Parent Network

• Orphanet

• Duane's Retraction Syndrome - Yahoo! Groups

• Genetics and Rare Diseases Information Center

• Finding Reliable Health Information Online