{
  "abstract": "Duane retraction syndrome (DRS) with mechanical and innervational upshoot or downshoot poses a significant surgical challenge. We report a case of bilateral, asymmetric exotropic DRS with both mechanical and innervational downshoot and describe its successful surgical management. A 28 year old female presented with an outward deviation of the right eye since birth. Examination revealed a -3 limitation of abduction in the right eye (RE) with a downshoot on abduction. The left eye (LE) showed a -2 limitation of adduction and -4 limitation of abduction, along with both upshoot and downshoot on abduction. She also exhibited narrowing of the palpebral fissure and globe retraction on abduction, with widening of the palpebral fissure on adduction. She reported no diplopia or abnormal head posture and alternated fixation between each eye. We performed a recession of the right lateral rectus muscle with Y-splitting for her. This intervention improved the exotropia from 45 prism dioptres base-in to 18 prism dioptres base-in and significantly reduced the downshoot in both eyes. We hypothesize that the improvement in the unoperated eye was due to her developing a -2 limitation of adduction postoperatively in her RE and a shift in preferred fixation to the left eye. The patient was highly satisfied with the surgical outcome. Y-split lateral rectus recession is an effective procedure for addressing significant upshoot and downshoot in Duane syndrome. We advocate staged surgery in bilateral cases, as our experience suggests that altering fixation through unilateral surgery can lead to functional improvement in the contralateral eye, resulting in a satisfactory outcome for the patient.",
  "authors": [
    {
      "affiliations": [
        "St James’s Hospital University Hospital, Leeds, UK"
      ],
      "name": "Andrew"
    },
    {
      "affiliations": [
        "St James’s Hospital University Hospital, Leeds, UK"
      ],
      "name": "Shaker"
    },
    {
      "affiliations": [
        "St James’s Hospital University Hospital, Leeds, UK"
      ],
      "name": "Jian"
    },
    {
      "affiliations": [
        "St James’s Hospital University Hospital, Leeds, UK"
      ],
      "name": "Chew"
    },
    {
      "affiliations": [
        "St James’s Hospital University Hospital, Leeds, UK"
      ],
      "name": "Devina"
    },
    {
      "affiliations": [
        "St James’s Hospital University Hospital, Leeds, UK"
      ],
      "name": "Gogi"
    }
  ],
  "title": "130036 Y-split lateral rectus recession for bilateral exotropic duane retraction syndrome with severe downshoot: a case report",
  "uid": "3853cffd-f83c-5b8a-bfb0-166df43c547d"
}