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Case Reports
. 2025 Jul 6;17(7):e87397.
doi: 10.7759/cureus.87397. eCollection 2025 Jul.

Surgical Management of a Prominent Adduction-Induced Upshoot in Duane Retraction Syndrome Type III: A Case Report

Miwa Komori  1 , Miho Sato  1 , Akari Arakawa  1 , Hiroki Kaneko  1 , Akiko Hikoya  1
Affiliations
Case Reports

Surgical Management of a Prominent Adduction-Induced Upshoot in Duane Retraction Syndrome Type III: A Case Report

Miwa Komori et al. Cureus. .

Abstract

Duane retraction syndrome (DRS) with good primary gaze alignment and no abnormal head posture is often managed conservatively to avoid worsening alignment. However, surgical intervention may be considered when significant cosmetic concerns are present. We present the case of a 29-year-old male patient with type III DRS of the right eye and a prominent upshoot. Despite having good primary gaze alignment, the patient desired cosmetic improvement. Forced duction testing revealed restrictions in multiple directions. Based on the spring-back balance test, we performed an 8.0 mm recession of the lateral rectus muscle and a 6.0 mm recession with partial nasal transposition of the superior rectus muscle. One year postoperatively, the vertical deviation had improved to 8 prism diopters (PD) at distance and 12 PD at near. The upshoot was significantly reduced, and there were no new limitations or diplopia. The patient achieved cosmetic satisfaction. Combined lateral and superior rectus recession effectively reduced an adduction-induced upshoot in DRS type III. Surgery may be considered for patients with good primary gaze alignment and significant cosmetic concerns.

Keywords: abnormal ocular movement; cosmetic concern; duane retraction syndrome; forced duction test; lateral rectus muscle recession; spring-back balance test; strabismus surgery; superior rectus muscle recession; upshoot; vertical deviation.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: Hiroki Kaneko declare(s) a grant from Senju Pharmaceutical Co., Ltd. Financial relationship: Category F, Class IV. Hiroki Kaneko declare(s) a grant from AMO Japan K.K. Financial relationship: Category F, Class IV. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Preoperative nine-gaze photographs
Mild hypertropia in the primary gaze position and a prominent upshoot during left gaze (yellow arrow).
Figure 2
Figure 2. Preoperative duction photographs of the right eye
Limitation of abduction and adduction (-2 each), with narrowing of the palpebral fissure on left gaze.
Figure 3
Figure 3. Postoperative nine-gaze photographs at one month
Reduced hypertropia and improved upshoot (indicated by yellow arrow).
Figure 4
Figure 4. Postoperative nine-gaze photographs at one year
Stable alignment and sustained cosmetic improvement.
See this image and copyright information in PMC

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