Poor results after recession of both medial rectus muscles in unilateral small-angle Duane's syndrome, type I

Purpose: To eliminate an abnormal face turn in unilateral Duane's syndrome, type 1, the medial rectus muscle of the Duane's eye is commonly recessed. Additional recession of the normal contralateral medial rectus muscle has been advocated in selected cases, although little has been published regarding this technique. We present poor results in. a small consecutive series. Methods. Four consecutive cases of unilateral Duane's syndrome, type 1, with small-angle primary position esotropia are retrospectively reviewed with attention to postoperative face turn. In all cases, the medial rectus muscle of the "normal" eye was recessed as was the medial rectus muscle of the Duane's eye. Results. Two subjects showed little to no improvement in face turn; one subject developed an increased turn; and the last subject developed a consecutive exotropia. Conclusions: In small-angle Duane's syndrome, type 1, recession of the normal medial rectus may decrease the positive effects of recessing the Duane's medial rectus muscle with respect to face turn as well as increase the risk of consecutive exotropia. An alternate theory of normal-eye Duane's surgery is proposed.