Conservative Management of Bilateral Type I Duane Retraction Syndrome with Prism Correction: A Case Report

Abstract

Background: Duane Retraction Syndrome (DRS) is a rare congenital cranial dysinnervation disorder characterised by limitation of horizontal eye movements, globe retraction, and narrowing of the palpebral fissure on adduction. Surgical correction is generally reserved for patients with significant abnormal head posture, primary position deviation, or cosmetically unacceptable globe retraction. Published evidence on successful non-surgical management of bilateral Type I Duane Retraction Syndrome using prism therapy remains limited. This case demonstrates sustained functional improvement with bilateral base-in prisms, avoiding surgical intervention over six months of follow-up. Aim: To report the successful conservative management of bilateral Type I Duane Retraction Syndrome using bilateral base-in prism therapy and to highlight prism correction as a viable non-surgical treatment option in carefully selected patients, potentially avoiding surgical intervention. Methods: A detailed clinical evaluation was performed, including best-corrected visual acuity, prism bar cover test, ocular motility assessment, anterior and posterior segment examination, and binocular vision assessment. The patient was managed conservatively with bilateral base-in prism correction and followed for six months to assess functional and clinical outcomes. Case Presentation: A 6-year-old female presented with a compensatory right face turn since early childhood. Best-corrected visual acuity was 6/6 in both eyes. Ocular motility examination revealed bilateral Type I DRS with bilateral limitation of abduction graded as −2 and mild (Grade 1) globe retraction with palpebral fissure narrowing on adduction, graded according to the clinical severity grading described by Kekunnaya et al. (2016). The patient demonstrated a right face turn of approximately 5° for distance fixation and 10° for near fixation. Prism bar cover testing revealed an exodeviation of 8 prism dioptres at distance and 25 prism dioptres at near. Considering the mild abnormal head posture, satisfactory primary gaze alignment, preserved binocular single vision, and absence of amblyopia, bilateral 5-prism-dioptre base-in prisms were prescribed. Results: At the six-month follow-up, the patient demonstrated excellent adaptation to bilateral base-in prism correction, with complete resolution of the compensatory head posture while wearing the prisms. Best-corrected visual acuity, ocular alignment, and binocular single vision remained stable throughout follow-up. The patient achieved satisfactory functional outcomes without requiring surgical intervention. Conclusion: Bilateral base-in prism therapy may be an effective first-line treatment for selected patients with bilateral Type I Duane Retraction Syndrome presenting with mild compensatory head posture and preserved binocular function. Early conservative management can provide excellent functional outcomes and may obviate the need for surgery.