42 Questions
What is the main cause of Duane's Syndrome?
Innervation of the LR by extra branches of the third nerve
Browns Syndrome is more common in males.
False
What is the aim of surgery in Duane's Syndrome?
To place the field of binocular vision more centrally, enlarging it if possible, and to overcome or reduce the head posture
Duane's Syndrome can be associated with ______________________ syndromes.
Goldenhar's or Kippel Feil
What is the most common type of Duane's Syndrome?
Type 1
Duane's Syndrome is always bilateral.
False
Match the following conditions with their characteristics:
Duane's Syndrome = Caused by innervation of the LR by extra branches of the third nerve Browns Syndrome = Anomaly of the superior oblique muscle
What is the result of fibrosis of the LR in Duane's Syndrome?
Mechanical deviation
What is a characteristic of Brown's syndrome?
Limitation of elevation in adduction
Surgery is the first line of treatment for Brown's syndrome.
False
What is the muscle sequalae in unilateral right Brown's syndrome?
Underaction of the RSO and overaction of contralateral synergist (SR)
In some acquired cases of Brown's syndrome, an audible ______________ may be heard when the eye suddenly shoots up.
click
Match the following characteristics of Brown's syndrome:
Limitation of elevation in adduction = Characteristic of Brown's syndrome Chin elevation with head tilted to affected side = Characteristic of Brown's syndrome A or V pattern = Characteristic of Brown's syndrome Unilateral ptosis = Not a characteristic of Brown's syndrome
What is the outcome in a significant number of patients with early onset of Brown's syndrome?
Spontaneous recovery over a long period
What is the mechanical restriction that limits movement in Brown's syndrome?
SO tendon sheath
Brown's syndrome is always bilateral.
False
What is the characteristic of Brown's syndrome that mimics an IO palsy?
Limitation of elevation in adduction
In some acquired cases of Brown's syndrome, an audible ______________ may be heard when the eye suddenly shoots up.
click
Match the following muscle sequela with their descriptions in unilateral right Brown's syndrome:
Underaction of the RSO = Muscle sequela in unilateral right Brown's syndrome Overaction of the contralateral synergist (SR) = Muscle sequela in unilateral right Brown's syndrome
What is the outcome in a significant number of patients with early onset of Brown's syndrome?
Spontaneous recovery over a long period
What is the result of a simultaneous contraction of the MR and LR in Duane's Syndrome?
Retraction of the globe
Duane's Syndrome is always unilateral.
False
What is the main reason for the limitation of abduction in Duane's Syndrome?
Innervation of the LR by extra branches of the third nerve in place of an absent or atrophic 6th nerve.
In Duane's Syndrome, the affected eye will have ______________ of the palpebral aperture on adduction.
narrowing
What is the characteristic of the A pattern in Duane's Syndrome?
Abduct better on depression
Browns Syndrome is more common in males and left eyes.
False
Match the following characteristics of Duane's Syndrome with their corresponding types:
Type 1 = Marked limitation of abduction Type 2 = Marked limitation of adduction Type 3 = Limitation of both abduction and adduction
What is the primary goal of surgery in Duane's Syndrome?
To place the field of binocular vision more centrally, enlarging if possible, and to overcome or reduce the head posture.
What is the mechanical restriction that limits movement in Brown's syndrome?
All of the above
Surgery is the first line of treatment for Brown's syndrome.
False
What is the characteristic of Brown's syndrome that mimics an IO palsy?
Limitation of elevation in adduction
In some acquired cases of Brown's syndrome, an audible ______________ may be heard when the eye suddenly shoots up.
click
Match the following muscle sequela with their descriptions in unilateral right Brown's syndrome:
Underaction of the RSO = Muscle sequela in unilateral right Brown's syndrome Overaction of the contralateral SR = Muscle sequela in unilateral right Brown's syndrome Overaction of the IO = Acquired cases of Brown's syndrome Underaction of the LR = Not a characteristic of Brown's syndrome
What is the outcome in a significant number of patients with early onset of Brown's syndrome?
Spontaneous recovery over a long period
What is the primary cause of the limitation of abduction in Duane's Syndrome?
Innervation of the LR by extra branches of the third nerve
Duane's Syndrome is always bilateral.
False
What is the characteristic of the affected eye on adduction in Duane's Syndrome?
retraction of the globe with narrowing of the palpebral aperture
Duane's Syndrome can be associated with ______________________ syndromes.
Goldenhar's or Kippel Feil
Which of the following is a characteristic of Brown's Syndrome?
Anomaly of the superior oblique muscle
Match the following types of Duane's Syndrome with their characteristics:
Type 1 = Marked limitation of abduction Type 2 = Marked limitation of adduction Type 3 = Limitation of both abduction and adduction
Browns Syndrome is more common in females and left eyes.
False
What is the primary goal of surgery in Duane's Syndrome?
to place the field of binocular vision more centrally and enlarge it if possible
Study Notes
Duane's Syndrome
- Congenital condition that can be unilateral or bilateral, with the left eye being more commonly affected
- Caused by extra branches of the third nerve innervating the lateral rectus (LR) in place of an absent or atrophic sixth nerve
- Results in simultaneous contraction of the medial rectus (MR) and LR, leading to retraction
- Fibrosis of the LR occurs, causing mechanical deviation
- Can be associated with Goldenhar's or Kippel Feil syndromes
- Clinical features include:
- Limitation of abduction with widening of the palpebral aperture
- Less marked limitation of adduction
- Retraction of the globe during adduction with narrowing of the palpebral aperture
- No diplopia
- Face turns towards the affected side (AHP)
- Upshoots of the affected eye on adduction are common
- Bulging of fat through the septum on adduction as the fat is displaced by the retracting globe
- Poor convergence
- A or V patterns
- Classification:
- Type 1: marked limitation of abduction
- Type 2: marked limitation of adduction
- Type 3: limitation of both abduction and adduction
- Management:
- Treatment of amblyopia and correction of refractive error
- Surgery may be indicated for decompensation, symptoms, cosmetically poor AHP, or cosmetically poor strabismus
Browns Syndrome
- Anomaly of the superior oblique muscle, mainly unilateral but can be bilateral
- More common in females and right eyes
- Can be acquired later through inflammation or trauma to the trochlear region
- Minimal movement due to mechanical restriction of the superior oblique (SO)
- Causes are uncertain and variable, including short tendon sheath or swelling of the SO
- Characteristics:
- Limitation of elevation in adduction
- Chin elevation with head tilted to affected side
- A or V pattern
- Little deviation on primary position
- Mimics an inferior oblique palsy
- Positive forced duction test
- In some acquired cases, an audible 'click' may be heard when the eye suddenly shoots up with the overacting inferior oblique
- Management:
- Spontaneous recovery over a long period in some patients with early onset
- Surgery is considered if marked decompensation of AHP or deviation in primary position occurs
Duane's Syndrome
- Congenital condition that can be unilateral or bilateral, with the left eye being more commonly affected
- Caused by extra branches of the third nerve innervating the lateral rectus (LR) in place of an absent or atrophic sixth nerve
- Results in simultaneous contraction of the medial rectus (MR) and LR, leading to retraction
- Fibrosis of the LR occurs, causing mechanical deviation
- Can be associated with Goldenhar's or Kippel Feil syndromes
- Clinical features include:
- Limitation of abduction with widening of the palpebral aperture
- Less marked limitation of adduction
- Retraction of the globe during adduction with narrowing of the palpebral aperture
- No diplopia
- Face turns towards the affected side (AHP)
- Upshoots of the affected eye on adduction are common
- Bulging of fat through the septum on adduction as the fat is displaced by the retracting globe
- Poor convergence
- A or V patterns
- Classification:
- Type 1: marked limitation of abduction
- Type 2: marked limitation of adduction
- Type 3: limitation of both abduction and adduction
- Management:
- Treatment of amblyopia and correction of refractive error
- Surgery may be indicated for decompensation, symptoms, cosmetically poor AHP, or cosmetically poor strabismus
Browns Syndrome
- Anomaly of the superior oblique muscle, mainly unilateral but can be bilateral
- More common in females and right eyes
- Can be acquired later through inflammation or trauma to the trochlear region
- Minimal movement due to mechanical restriction of the superior oblique (SO)
- Causes are uncertain and variable, including short tendon sheath or swelling of the SO
- Characteristics:
- Limitation of elevation in adduction
- Chin elevation with head tilted to affected side
- A or V pattern
- Little deviation on primary position
- Mimics an inferior oblique palsy
- Positive forced duction test
- In some acquired cases, an audible 'click' may be heard when the eye suddenly shoots up with the overacting inferior oblique
- Management:
- Spontaneous recovery over a long period in some patients with early onset
- Surgery is considered if marked decompensation of AHP or deviation in primary position occurs
Duane's Syndrome
- Congenital condition that can be unilateral or bilateral, with the left eye being more commonly affected
- Caused by extra branches of the third nerve innervating the lateral rectus (LR) in place of an absent or atrophic sixth nerve
- Results in simultaneous contraction of the medial rectus (MR) and LR, leading to retraction
- Fibrosis of the LR occurs, causing mechanical deviation
- Can be associated with Goldenhar's or Kippel Feil syndromes
- Clinical features include:
- Limitation of abduction with widening of the palpebral aperture
- Less marked limitation of adduction
- Retraction of the globe during adduction with narrowing of the palpebral aperture
- No diplopia
- Face turns towards the affected side (AHP)
- Upshoots of the affected eye on adduction are common
- Bulging of fat through the septum on adduction as the fat is displaced by the retracting globe
- Poor convergence
- A or V patterns
- Classification:
- Type 1: marked limitation of abduction
- Type 2: marked limitation of adduction
- Type 3: limitation of both abduction and adduction
- Management:
- Treatment of amblyopia and correction of refractive error
- Surgery may be indicated for decompensation, symptoms, cosmetically poor AHP, or cosmetically poor strabismus
Browns Syndrome
- Anomaly of the superior oblique muscle, mainly unilateral but can be bilateral
- More common in females and right eyes
- Can be acquired later through inflammation or trauma to the trochlear region
- Minimal movement due to mechanical restriction of the superior oblique (SO)
- Causes are uncertain and variable, including short tendon sheath or swelling of the SO
- Characteristics:
- Limitation of elevation in adduction
- Chin elevation with head tilted to affected side
- A or V pattern
- Little deviation on primary position
- Mimics an inferior oblique palsy
- Positive forced duction test
- In some acquired cases, an audible 'click' may be heard when the eye suddenly shoots up with the overacting inferior oblique
- Management:
- Spontaneous recovery over a long period in some patients with early onset
- Surgery is considered if marked decompensation of AHP or deviation in primary position occurs
Learn about Duane's Syndrome, a congenital condition affecting eye movement, its causes, symptoms, and associated syndromes like Goldenhar's and Kippel Feil.
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