Non-surgical Management of Abnormal Head Posture in Duane Retraction Syndrome
Abstract
Duane retraction syndrome (DRS) is a congenital ocular motility disorder characterized by dysinnervation of the lateral rectus muscle, globe retraction and palpebral fissure narrowing on adduction, and limitation of horizontal eye movements. Many affected children adopt an abnormal head posture (AHP) to maintain binocular single vision and avoid diplopia. When such postures appear early in life and persist through the years of rapid craniofacial growth, they may predispose to facial asymmetry and musculoskeletal imbalance. Surgical correction can improve alignment and reduce AHP in selected cases but is often deferred in very young children or when primary position deviation is small. This short communication summarizes the patterns of AHP in the main clinical types of DRS, reviews key elements of non-surgical management—including amblyopia therapy, optical correction, simple positioning strategies, and the use of the patch test—and highlights the importance of early intervention to prevent permanent craniofacial changes.
1. Barry BJ, Whitman MC, Hunter DG, Engle EC. Duane Syndrome Synonyms: Duane Anomaly, Isolated; Duane Retraction Syndrome; Stilling-Turk-Duane Syndrome.
2. Kocamaz M, Aygit ED, Inal A, Ocak OB, Cicek U, Gokyigit B. Duane retraction syndrome and accompanying ocular abnormalities. Beyoglu eye journal. 2019;4(1):28.
3. Muni I, Kumar B. Duane retraction syndrome. StatPearls [Internet]. StatPearls Publishing; 2023.
4. Kekunnaya R, Negalur M. Duane retraction syndrome: causes, effects and management strategies. Clinical Ophthalmology. 2017:1917-1930.
5. DeRespinis PA, Caputo AR, Wagner RS, Guo S. Duane's retraction syndrome. Survey of ophthalmology. 1993;38(3):257-288.
6. Masoomian B, Akbari MR, Mirmohamadsadeghi A, et al. Clinical characteristics and surgical approach in Duane retraction syndrome: a study of 691 patients. Japanese Journal of Ophthalmology. 2022;66(5):474-480.
7. Negalur M, Sachdeva V, Kekunnaya R. Superior Rectus Transposition in the management of duane retraction syndrome: current Insights. Clinical Ophthalmology. 2022:201-212.
8. Mohan K, Sharma A, Pandav SS. Differences in epidemiological and clinical characteristics between various types of Duane retraction syndrome in 331 patients. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2008;12(6):576-580.
9. Akbari MR, Khorrami-Nejad M, Kangari H, Baghban AA, Pazouki MR. Ocular abnormal head posture: a literature review. Journal of Current Ophthalmology. 2021;33(4):379-387.
10. Khorrami-Nejad M, Akbari MR, Kangari H, Akbarzadeh Baghban A, Masoomian B, Ranjbar-Pazooki M. Abnormal head posture in unilateral superior oblique palsy. Journal of Binocular Vision and Ocular Motility. 2021;71(1):16-23.
11. Mitchell PR. Ocular torticollis. Transactions of the American Ophthalmological Society. 1999;97:697.
12. Prasad P, Saxena A, Saxena R. Duane syndrome: An overview on the current management. Taiwan Journal of Ophthalmology. 2023;13(4):489-499. doi:10.4103/tjo.TJO-D-23-00078
13. Thakre SR, Mishrikotkar JP, Deshmukh PA. Face turns in Type 1 Duane's retraction syndrome–Right? Left? or none? Journal of Clinical Ophthalmology and Research. 2019;7(3):101-104.
14. Xia W, Yao J, Zhao X, Jiang C, Ling L, Zhao C. Restrictive strabismus caused by infantile myositis masquerading as Duane retraction syndrome. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2025:104611.
15. Akbari MR, Nejad MK, Askarizadeh F, Pour FF, Pazooki MR, Moeinitabar MR. Facial asymmetry in ocular torticollis. Journal of current ophthalmology. 2015;27(1-2):4-11.
16. Dotan G, Jain S, Vagge A, Nelson LB. Diagnosis and management of Strabismus syndromes. Journal of Pediatric Ophthalmology & Strabismus. 2022;59(4):210-212.
17. Yüksel D, de Xivry J-JO, Lefèvre P. Review of the major findings about Duane retraction syndrome (DRS) leading to an updated form of classification. Vision research. 2010;50(23):2334-2347.
18. Greenberg MF, Pollard ZF. Ocular plagiocephaly: ocular torticollis with skull and facial asymmetry. Ophthalmology. 2000;107(1):173-178.
19. Akbari MR, Khorrami-Nejad M, Kangari H, Baghban AA, Pazouki MR. Facial asymmetry in unilateral congenital superior oblique muscle palsy. Optometry and Vision Science. 2021;98(11):1248-1254.
20. Dahal M, Shyangbo R, Kaiti R. Review Duane’s retraction syndrome diagnosis and treatment. 2021;
21. Al-Dabet S, Turaev S, Zaki N. Ocular-induced abnormal head postures: A systematic review and analysis. Survey of Ophthalmology. 2025;
22. Akbari MR, Khorrami-Nejad M, Kangari H, et al. Does head tilt influence facial appearance more than head turn? Journal of Ophthalmic & Vision Research. 2023;18(3):297.
23. Akbari MR, Khorrami-Nejad M, Amiri MA, Baghban AA, Khosravi B, Nourizad S. Facial asymmetry in unilateral duane retraction syndrome. Optometry and Vision Science. 2019;96(12):920-924.
24. Nucci P, Curiel B. Abnormal head posture due to ocular problems-a review. Current Pediatric Reviews. 2009;5(2):105-111.
25. Lau FH, Fan DS, Sun KK, Yu C, Wong C, Lam DS. Residual torticollis in patients after strabismus surgery for congenital superior oblique palsy. British journal of ophthalmology. 2009;93(12):1616-1619.
26. Gaur N, Sharma P. Management of Duane retraction syndrome: A simplified approach. Indian journal of ophthalmology. 2019;67(1):16-22.
27. Alani HHAA. Prevalence of anisometropia and amblyopia in duane retraction syndrome of patients attened ibn Al-Haitham Teaching Eye Hospital. Revista Latinoamericana de Hipertensión. 2019;14(3):260-264.
28. Khorrami-Nejad M, Akbari MR, Sadeghi M, et al. Refractive features and amblyopia in Duane's Retraction Syndrome: A review of the 582 patients. Journal of Optometry. 2024;17(3):100508.
29. Wright KW, Strube YNJ. Strabismus Syndromes. Color Atlas Of Strabismus Surgery: Strategies and Techniques. Springer; 2025:39-51.
30. Portal MR. Positional plagiocephaly.
31. Dooley H, Berman M, Mwaturura C. Ocular torticollis:'A tilt in perspective'. Australian Journal of General Practice. 2019;48(8):520-522.
2. Kocamaz M, Aygit ED, Inal A, Ocak OB, Cicek U, Gokyigit B. Duane retraction syndrome and accompanying ocular abnormalities. Beyoglu eye journal. 2019;4(1):28.
3. Muni I, Kumar B. Duane retraction syndrome. StatPearls [Internet]. StatPearls Publishing; 2023.
4. Kekunnaya R, Negalur M. Duane retraction syndrome: causes, effects and management strategies. Clinical Ophthalmology. 2017:1917-1930.
5. DeRespinis PA, Caputo AR, Wagner RS, Guo S. Duane's retraction syndrome. Survey of ophthalmology. 1993;38(3):257-288.
6. Masoomian B, Akbari MR, Mirmohamadsadeghi A, et al. Clinical characteristics and surgical approach in Duane retraction syndrome: a study of 691 patients. Japanese Journal of Ophthalmology. 2022;66(5):474-480.
7. Negalur M, Sachdeva V, Kekunnaya R. Superior Rectus Transposition in the management of duane retraction syndrome: current Insights. Clinical Ophthalmology. 2022:201-212.
8. Mohan K, Sharma A, Pandav SS. Differences in epidemiological and clinical characteristics between various types of Duane retraction syndrome in 331 patients. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2008;12(6):576-580.
9. Akbari MR, Khorrami-Nejad M, Kangari H, Baghban AA, Pazouki MR. Ocular abnormal head posture: a literature review. Journal of Current Ophthalmology. 2021;33(4):379-387.
10. Khorrami-Nejad M, Akbari MR, Kangari H, Akbarzadeh Baghban A, Masoomian B, Ranjbar-Pazooki M. Abnormal head posture in unilateral superior oblique palsy. Journal of Binocular Vision and Ocular Motility. 2021;71(1):16-23.
11. Mitchell PR. Ocular torticollis. Transactions of the American Ophthalmological Society. 1999;97:697.
12. Prasad P, Saxena A, Saxena R. Duane syndrome: An overview on the current management. Taiwan Journal of Ophthalmology. 2023;13(4):489-499. doi:10.4103/tjo.TJO-D-23-00078
13. Thakre SR, Mishrikotkar JP, Deshmukh PA. Face turns in Type 1 Duane's retraction syndrome–Right? Left? or none? Journal of Clinical Ophthalmology and Research. 2019;7(3):101-104.
14. Xia W, Yao J, Zhao X, Jiang C, Ling L, Zhao C. Restrictive strabismus caused by infantile myositis masquerading as Duane retraction syndrome. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2025:104611.
15. Akbari MR, Nejad MK, Askarizadeh F, Pour FF, Pazooki MR, Moeinitabar MR. Facial asymmetry in ocular torticollis. Journal of current ophthalmology. 2015;27(1-2):4-11.
16. Dotan G, Jain S, Vagge A, Nelson LB. Diagnosis and management of Strabismus syndromes. Journal of Pediatric Ophthalmology & Strabismus. 2022;59(4):210-212.
17. Yüksel D, de Xivry J-JO, Lefèvre P. Review of the major findings about Duane retraction syndrome (DRS) leading to an updated form of classification. Vision research. 2010;50(23):2334-2347.
18. Greenberg MF, Pollard ZF. Ocular plagiocephaly: ocular torticollis with skull and facial asymmetry. Ophthalmology. 2000;107(1):173-178.
19. Akbari MR, Khorrami-Nejad M, Kangari H, Baghban AA, Pazouki MR. Facial asymmetry in unilateral congenital superior oblique muscle palsy. Optometry and Vision Science. 2021;98(11):1248-1254.
20. Dahal M, Shyangbo R, Kaiti R. Review Duane’s retraction syndrome diagnosis and treatment. 2021;
21. Al-Dabet S, Turaev S, Zaki N. Ocular-induced abnormal head postures: A systematic review and analysis. Survey of Ophthalmology. 2025;
22. Akbari MR, Khorrami-Nejad M, Kangari H, et al. Does head tilt influence facial appearance more than head turn? Journal of Ophthalmic & Vision Research. 2023;18(3):297.
23. Akbari MR, Khorrami-Nejad M, Amiri MA, Baghban AA, Khosravi B, Nourizad S. Facial asymmetry in unilateral duane retraction syndrome. Optometry and Vision Science. 2019;96(12):920-924.
24. Nucci P, Curiel B. Abnormal head posture due to ocular problems-a review. Current Pediatric Reviews. 2009;5(2):105-111.
25. Lau FH, Fan DS, Sun KK, Yu C, Wong C, Lam DS. Residual torticollis in patients after strabismus surgery for congenital superior oblique palsy. British journal of ophthalmology. 2009;93(12):1616-1619.
26. Gaur N, Sharma P. Management of Duane retraction syndrome: A simplified approach. Indian journal of ophthalmology. 2019;67(1):16-22.
27. Alani HHAA. Prevalence of anisometropia and amblyopia in duane retraction syndrome of patients attened ibn Al-Haitham Teaching Eye Hospital. Revista Latinoamericana de Hipertensión. 2019;14(3):260-264.
28. Khorrami-Nejad M, Akbari MR, Sadeghi M, et al. Refractive features and amblyopia in Duane's Retraction Syndrome: A review of the 582 patients. Journal of Optometry. 2024;17(3):100508.
29. Wright KW, Strube YNJ. Strabismus Syndromes. Color Atlas Of Strabismus Surgery: Strategies and Techniques. Springer; 2025:39-51.
30. Portal MR. Positional plagiocephaly.
31. Dooley H, Berman M, Mwaturura C. Ocular torticollis:'A tilt in perspective'. Australian Journal of General Practice. 2019;48(8):520-522.
| Issue | Articles in Press | |
| Section | Review Article(s) | |
| Keywords | ||
| Abnormal head posture; Abnormal head posture; Duane retraction syndrome; Duane retraction syndrome; Non-surgical Management | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Naseri M. Non-surgical Management of Abnormal Head Posture in Duane Retraction Syndrome. jmr. 2026;(-).
