Type IV Duane syndrome has been called simultaneous abduction, synergistic divergence, the "splits", and perversion of the extraocular muscles.1,3,6,7 Type IV Duane syndrome has previously been described in the literature, but only case reports have been reported. We characterize Type IV Duane syndrome as exotropia in primary gaze, face turn DUANE'S SYNDROME PATIENTS Type DISTRIBUTION OF CLINICAL TYPES IN DUANE'S SYNDROME Type Total No. of Eyes 56 (73%) (10/0) 20 (26%) 77 (100%) No. of Patients* 15 Straight 13 (28%) Towardt 31 (68%) 3 (20%) Information available for 62 of 63 patients. With respect to side of involvement. TABLE 7 ANOMALOUS VERTICAL MOVEMENTS IN DUANE'S SYNDROME PATIENTS Puligadda RK (2015) Surgical Planning for Duane Retraction Syndrome. J Clin Res Ophthalmol 2(2): 019-025. DOI: 10.17352/2455-1414.000012. 019 Abstract. Introduction: Duane retraction syndrome (DRS) a type of relatively rare type of restrictive strabismus. Methods and results: Six cases of DRS comprising of all sub types and their outcome was Duane syndrome (DS) is a rare, congenital (present from birth) eye movement disorder. Most patients are diagnosed by the age of 10 years and DS is more common in girls (60 percent of the cases) than boys (40 percent of the cases). DS is a miswiring of the eye muscles, causing some eye muscles to contract when they shouldn't and other eye gene, CHN1, is located on chromosome 2 (2q31), SALL4 mutations on chromosome 20 (20q13) which causes Duane radial ray syndrome (with dysplasia of radial bone). AA: It is quite common to be hereditary. In a study we had on 67 patients with Duane syndrome, only 1 patient showed a positive family history (unpublished) SK: Agree. It can run in Duane syndrome is the most common form of aberrant innervation . It is the result of a maldevelopment in which the sixth cranial nerve either does not form or forms only partially, resulting in absence or greatly diminished lateral rectus muscle (LR) recruitment on attempted abduction [1, 2].In addition, branches of the third cranial nerve are redirected to aberrantly innervate the LR syndrome, Duane-Radial Ray syndrome, and some cases of Holt-Oram syndrome with a pathogenic variant in the SALL4 gene, demonstrating a continuous in phenotypes [1]. To date 20 pathogenic variants have been described, 19 of them generate a change in the reading frame and one affects the splicing site [8-10]. Duane syndrome is a congenital rare type of strabismus most commonly characterized by the inability of the eye to move outward. The syndrome was first described by ophthalmologists Jakob Stilling (1887) and Siegmund Türk (1896), and subsequently named after Alexander Duane, who discussed the disorder in more detail in 1905.. Other names for this condition include: Duane's retraction syndrome Duane's syndrome, and Mein (I968) mentioned two cases ofdeafness in her series of77 patients with Duane's syndrome. In a review ofvisual defects in deafchildren, Stockw,ell (1952) noted that one female showed absence ofthe lateral rectus muscles, possibly a case ofDuane's svndrome. Single cases of Duane's syndrome associated with the Klippel option for eliminating AHP and is our treatment of choice in patients with Duane's syndrome. The incidence of Duane's syndrome is 1% to 4% of strabismus patients.1 It is the most common type of congenital ocular aberrant innervation.2 Alexander Duane, as well as other authors, characterised this entity I Duane syndrome has been previously reported only once1-5. There is a progressive degenerati