Refractive and Visual Outcomes in Unilateral Duane Retraction Syndrome: Influence of Ocular Motility

Objectives: To compare the refractive profiles and clinical characteristics of affected and fellow eyes in unilateral Duane retraction syndrome (DRS), emphasize subtype-related variations, and assess the impact of motility restriction and ocular findings on refractive status. Materials and Methods: This retrospective cross-sectional study included 191 patients with unilateral DRS, comprising type I (n=162), type II (n=7), and type III (n=22). Best-corrected visual acuity (BCVA), cycloplegic autorefraction, astigmatism classification, and ocular alignment/motility findings were analyzed across DRS subtypes. Results: The mean age at examination was 6.67±7.13 years, and 62.3% of the patients were female. Amblyopia was observed in 23.0% of patients, anisometropia in 18.6%, and abnormal head posture in 52.7% of patients. Esotropia (42.0%) was more prevalent than exotropia (11.7%), and the majority of patients (61.4%) exhibited grade 4 horizontal limitation. Compared with fellow eyes, DRS eyes exhibited a substantially lower BCVA (p<0.001), higher spherical power (p=0.025), and greater cylindrical power (p<0.001). In both DRS (60.7%) and non-DRS (72.3%) eyes, the predominant pattern was with-the-rule astigmatism. There were no discernible variations in astigmatism subtypes among motility limitation grades or DRS subtypes. The cylindrical refractive error was independently associated with abnormal head posture (p=0.007) and horizontal deviation type (p=0.029) according to multiple regression analysis. Conclusion: Unilateral DRS is characterized by diminished visual function and increased refractive error, with cylindrical outcomes affected by head posture and type of deviation. The findings highlight the importance of integrating motility parameters into refractive evaluation and surgical planning in DRS.