Medical Research: Emerging Concepts and Applications Vol. 4

Duane Retraction Syndrome (DRS) is a congenital cranial dysinnervation disorder characterised by limitation of horizontal ocular movements, globe retraction, and narrowing of the palpebral fissure on adduction. This case report describes the conservative management of bilateral Type I DRS using bilateral base-in prism correction. A 6-year-old girl presented with a compensatory right face turn present since early childhood. Best-corrected visual acuity was 6/6 in both eyes. Ocular motility examination demonstrated bilateral limitation of abduction graded as −2, with mild Grade 1 globe retraction and palpebral fissure narrowing on adduction. The compensatory right face turn measured approximately 5° for distance fixation and 10° for near fixation. Prism bar cover testing showed an exodeviation of 8 prism dioptres at distance and 25 prism dioptres at near. Because primary gaze alignment was satisfactory, binocular single vision was preserved, amblyopia was absent, and the abnormal head posture was mild, a 5-prism-dioptre base-in prism was prescribed for each eye. At six months, the patient had adapted well to prism wear, and the compensatory head posture had resolved while the prisms were worn. Best-corrected visual acuity, ocular alignment, and binocular single vision remained stable throughout follow-up. This case indicates that bilateral base-in prism correction may provide a useful conservative option for carefully selected patients with bilateral Type I DRS and mild abnormal head posture.