Motility Disturbances

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Identifier 92_43
Title Motility Disturbances
Subject Synergistic Divergence, Duane's syndrome, type II, synergistic divergence
Description This 5-year-old child presented with a 70 PD exotropia OS and a right face turn. She had a CT scan of the head at age 4 months that was normal , and she was felt to have an isolated left medial rectus paresis. Her acuity was 20/20 OU. She could fuse with a large face turn, and was orthomorphic is extreme left gaze. On attempted right gaze, there was no adduction OS, and both eyes were seen to have paradoxical simultaneous abduction. The left eye would be seen to abduct as soon as the right eye abducted past the midline. In left gaze, the right eye would fully adduct and the left eye would go left, but would not abduct as fully as it would in right gaze. The diagnosis is synergistic divergence, a variant of Duane's syndrome, type II. The patient did not have fissure changes or retraction of the globe. it was felt that there was a paradoxical innervation here, with increased right lateral rectus firing on left gaze. Innervation of the right medial rectus, in the one such case recorded by EMG, was essentially normal. In Duane's syndrome, type II, the lateral rectus is fired both in abduction and adduction. The major difference between this and synergistic divergence is the marked firing of the involved lateral rectus on attempted adduction.
Creator AAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology Society
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Type Image
Format image/jpeg
Relation is Part of Case 140
Rights Management Copyright 2002. For further information regarding the rights to this collection, please visit:
Holding Institution North American Neuro-Ophthalmology Association. NANOS Executive Office 5841 Cedar Lake Road, Suite 204, Minneapolis, MN 55416
Collection Neuro-ophthalmology Virtual Education Library: NOVEL
Contributor Primary Larry P. Frohman, MD, UMDNJ-New Jersey Medical School
References Wagner RS, Caputo AR, Frohman LP, Congenital unilateral adduction deficit with simultaneous abduction: a variant of Duane's syndrome. Ophthalmology 1987,94:1049-1053
Source AAO/NANOS Clinical neuro-ophthalmology : image collection for ophthalmic practitioners. American Academy of Ophthalmology [electronic resource], [San Francisco, Calif.] : AAO, c1999.
ARK ark:/87278/s63z1690
Setname ehsl_novel_aao_nanos
Date Created 2004-11-17
Date Modified 2014-08-28
ID 177020
Reference URL