# Type III Duane Retraction Syndrome and Monocular Elevation Deficiency, Simultaneous Presentation in a 16-year-old girl

## TL;DR

A 16-year-old girl was found to have both Type III Duane Retraction Syndrome and Monocular Elevation Deficiency in the same eye, a combination that has not been previously reported.

## Contribution

This case is the first documented simultaneous presentation of Type III DRS and MED in a single patient.

## Key findings

- The patient exhibited globe retraction, ptosis, and hypotropia consistent with Type III DRS.
- The patient also showed signs of Monocular Elevation Deficiency, including limited upward gaze in the right eye.
- This combination of two distinct strabismus conditions has not been previously reported in medical literature.

## Abstract

Duane Retraction Syndrome (DRS) and Monocular Elevation Deficiency (MED) are two distinct congenital strabismus entities that have not been reported simultaneously until now. Thirty percent of individuals with DRS present with various congenital ocular and non-ocular anomalies.

A 16-year-old girl presented with right eye ptosis and ocular deviation since birth. The patient’s hypotropia increased in the upward gaze. She also exhibited small-angle exotropia in the primary position, along with the limitation of both abduction and adduction. The patient had globe retraction and increased ptosis in adduction. Strabismus manifestation in the patient was consistent with concurrent type III DRS and MED in the right eye.