To the Editor.
—In a recent article, Nelson1 described the unusual occurrence of marked adduction deficiency in two patients who were thought to have Duane's retraction syndrome (DRS) following a large, but not immense, medial rectus recession. This most unusual occurrence was felt to be significant, and Dr Nelson recommended care in performing a large medial rectus recession in DRS because of such an unexpected result.The diagnosis of DRS in these patients must be questioned. In the first case, the patient had 35 prism diopters (PD) of esotropia in primary position. Although this may occur in DRS, it is distinctly unusual, given the experience of Wong et al2 and Isenberg and Urist.3 The illustrations of the patient do demonstrate narrowing of the lid fissure on adduction and widening of the lid fissure on attempted abduction, but the limitation of adduction of the left eye on right
Metz HS. Duane's Retraction Syndrome and Severe Adduction Deficiency. Arch Ophthalmol. 1986;104(11):1586. doi:10.1001/archopht.1986.01050230024011