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. 2016 Aug;20(4):301-4.
doi: 10.1016/j.jaapos.2016.05.012. Epub 2016 Jul 2.

Type 4 Duane syndrome

Joshua A Schliesser  1 , Derek T Sprunger  2 , Eugene M Helveston  2
Affiliations
Free article

Type 4 Duane syndrome

Joshua A Schliesser et al. J AAPOS. 2016 Aug.
Free article

Abstract

Purpose: To identify cases of synergistic divergence whose characteristics suggest that this entity is a form of Duane syndrome.

Methods: The records of all patients with a Duane syndrome diagnosis, including standardized eye position photographs, from the E-Consultation program of Cybersight, Orbis International were analyzed.

Results: A total of 350 Duane syndrome cases were identified. Of these, 19 (5%) had features consistent with synergistic divergence, or type 4 Duane syndrome. Of the 19, 16 (84%) were male, 15 (79%) had palpebral fissure narrowing, all had anomalous head posture, and 18 (95%) were exotropic. Only 9 (47%) patients were reported to have undergone surgery.

Conclusions: Synergistic divergence is a rare entity with features similar to those of Duane syndrome. We suggest that this entity be classified as type 4 Duane syndrome, because it has unique findings and an innervation pattern that differs from the other 3 recognized types.

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Comment in

  • Exotropic Duane syndrome with synergistic divergence.
    Khan AO. Khan AO. J AAPOS. 2016 Oct;20(5):470. doi: 10.1016/j.jaapos.2016.07.217. Epub 2016 Jul 22. J AAPOS. 2016. PMID: 27457503 No abstract available.
  • Reply.
    Schliesser JA, Sprunger DT, Helveston EM. Schliesser JA, et al. J AAPOS. 2016 Oct;20(5):471. doi: 10.1016/j.jaapos.2016.07.225. Epub 2016 Sep 21. J AAPOS. 2016. PMID: 27664848 No abstract available.