Victoria Erickson, Kimberly Merrill, Collin M McClelland, Christian Larson, Michael S Lee
{"title":"Comparing the Single Maddox Rod Test to the Alternate Cover Test in Normal Individuals.","authors":"Victoria Erickson, Kimberly Merrill, Collin M McClelland, Christian Larson, Michael S Lee","doi":"10.1080/2576117X.2026.2726016","DOIUrl":"https://doi.org/10.1080/2576117X.2026.2726016","url":null,"abstract":"<p><strong>Purpose: </strong>The single Maddox rod test (SMRT) is a rapid subjective method for detecting ocular misalignment. In this study, we compared the prism single Maddox rod test (PSMRT) to the prism alternate cover test (PACT) in normal individuals to see if there was any disagreement.</p><p><strong>Methods: </strong>Ocular alignment was measured at distance and near with the PSMRT and PACT in 52 normal participants. Secondary measurements included visual acuity, near point of convergence, and stereoacuity.</p><p><strong>Results: </strong>The difference between each participants' measurements at near (ΔX') was 4.44 ± 3.87 Δ (<i>p</i> < .001) meaning each participant was an average of 4.44 Δ more exophoric at near with the PSMRT compared to their measurement at near with the PACT. There was no significant difference between PSMRT and PACT at distance (-0.09 ± 1.33 Δ (<i>p</i> > .5)).</p><p><strong>Discussion: </strong>Among visually normal participants, the PSMRT measures more exophoria at near than the PACT. This difference may affect the interpretation of near alignment in various clinical settings, especially when evaluating patients with symptoms suggestive of convergence insufficiency. The PSMRT should be used with caution and be confirmed with the PACT when clinically indicated.</p>","PeriodicalId":37288,"journal":{"name":"Journal of Binocular Vision and Ocular Motility","volume":" ","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pilar Merino, Ariana Fuentes, Lourdes Bermejo, Juan Adan Guzmán de Villoria, Jacobo Yáñez-Merino
{"title":"Sixth Cranial Nerve Paresis Secondary to Intracranial Hypotension: Etiology, Clinical Characteristics, and Treatment.","authors":"Pilar Merino, Ariana Fuentes, Lourdes Bermejo, Juan Adan Guzmán de Villoria, Jacobo Yáñez-Merino","doi":"10.1080/2576117X.2026.2718672","DOIUrl":"10.1080/2576117X.2026.2718672","url":null,"abstract":"<p><p>Intracranial hypotension is a typically self-limiting or treatable condition characterized by orthostatic headache and neck stiffness. However, it may be severe and may be associated with neurological complications, particularly sixth cranial nerve palsy. We report two young women who presented to the emergency department with diplopia secondary to acute unilateral sixth cranial nerve paresis in the context of intracranial hypotension following anesthetic procedures. In both cases, clinical and radiological findings consistent with a cerebrospinal fluid (CSF) deficit were documented, including bilateral subdural collections in one case. One case required an epidural blood patch, which resulted in complete resolution, whereas the other resolved spontaneously. The clinical manifestations, radiological findings, and therapeutic options are reviewed. These cases underscore the importance of careful clinical and radiological assessment in patients with acute ophthalmoplegia, in whom orthostatic headache is a key diagnostic clue, as well as of treatment aimed at correcting the CSF deficit.</p>","PeriodicalId":37288,"journal":{"name":"Journal of Binocular Vision and Ocular Motility","volume":" ","pages":"61-64"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Davina A Malek, Jason A Greenfield, Francisco Lopez-Font, Michelle Falcone, Kara M Cavuoto
{"title":"Sensorimotor Disturbances After Extended Depth of Focus Intraocular Lens Implantation.","authors":"Davina A Malek, Jason A Greenfield, Francisco Lopez-Font, Michelle Falcone, Kara M Cavuoto","doi":"10.1080/2576117X.2026.2693416","DOIUrl":"10.1080/2576117X.2026.2693416","url":null,"abstract":"<p><p>Cataracts are the leading cause of reversible blindness in the world. Their prevalence is expected to dramatically increase with the anticipated global population growth by 2050, consequently increasing the need for cataract surgery. As cataract surgery evolves, novel types of intraocular lenses (IOLs) are also emerging. Extended depth of focus (EDOF) lenses are a recently introduced lens technology that was approved for commercial use in 2016. The lens optics create a focal zone with an overlap for near and far images, enabling an enhanced depth of focus for intermediate vision with little impact on distance vision. Reports of sensorimotor decompensation, such as ocular misalignment and diplopia, following cataract surgery have been described in the literature, particularly in patients with a history of strabismus or diplopia. However, there is very limited literature to determine if newer multifocal IOLs, such as EDOF lenses, carry the same risk of sensorimotor decompensation. The purpose of this report is to describe two cases with sensorimotor disturbances after uncomplicated bilateral EDOF IOL implantation, the first being decompensation of stereopsis in a patient with previously well-controlled accommodative esotropia, and the second involving the development of vertical diplopia post-operatively.</p>","PeriodicalId":37288,"journal":{"name":"Journal of Binocular Vision and Ocular Motility","volume":" ","pages":"58-60"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148309878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Superior Oblique Palsy: Characteristics and Treatment Outcomes.","authors":"Sanpaporn Uttamapinan, Chanikarn Preechawuttidej, Natthiya Lailaksiri, Supharat Jariyakosol, Parnchat Pukrushpan, Pokpong Praneeprachachon, Worawalun Honglertnapakul","doi":"10.1080/2576117X.2026.2703423","DOIUrl":"10.1080/2576117X.2026.2703423","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the characteristics, prognostic factors, and treatment outcomes in patients with superior oblique (SO) palsy.</p><p><strong>Methods: </strong>A retrospective review was conducted on patients diagnosed with SO palsy at King Chulalongkorn Memorial Hospital from January 2012 to October 2022. Patient demographics, etiology, preoperative strabismus evaluations, treatment approaches, and surgical outcomes were analyzed. Motor and sensory success criteria were ocular deviation ≤5 PD vertically, ≤10 PD horizontally, and the resolution of diplopia.</p><p><strong>Results: </strong>Among 57 patients, 43 (75.4%) had acquired SO palsy, most commonly due to ischemia (50.9%). Unilateral involvement was observed in 48 patients (84.2%), while 9 (15.8%) had bilateral SO palsy. Congenital cases had higher odds of requiring surgery (OR 30, 95% CI [3.55-253.86]; <i>p</i> < .001) compared to acquired cases that resolved spontaneously. Among 26 surgeries, inferior oblique (IO) myectomy was the most common (57.7%). Motor and sensory successes were achieved in 84.6% and 50% of cases respectively. Vertical deviation improved from 13 (6-20) to 0 (0-3) PD (<i>p</i> < .001) at distance and from 13 (6-20) PD to 0 (0-3) PD (<i>p</i> < .001) at near. Postoperative drift toward overcorrection was noted at both distance (-4 [-5 to -2] PD; <i>p</i> < .001) and near (-4 [-8 to -1] PD; <i>p</i> = .002) but stabilized by 12 months. The Harada-Ito procedure reduced extorsion in bilateral cases from 25 (22-30) to 5 (0-10) degrees (<i>p</i> < .001), correcting 10 (7.5-11) degrees for each operated eye (<i>p</i> = .02).</p><p><strong>Conclusions: </strong>SO palsy management requires individualized treatment. Congenital cases were more likely to require surgery. IO myectomy is effective for vertical deviations ≤15 PD, while larger misalignments need combined procedures. The Harada-Ito procedure corrected 10 (7.5-11) degrees of extorsion for each operated eye in bilateral SO palsy. Aiming for early small residual hypertropia is advisable due to postoperative drift to overcorrection, particularly in congenital cases with large fusional amplitudes.</p>","PeriodicalId":37288,"journal":{"name":"Journal of Binocular Vision and Ocular Motility","volume":" ","pages":"43-51"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A Pilot Study to Compare a Portable Tablet Perimeter with Humphrey Field Analyzer in Patients with Neuro-Ophthalmic Disorders.","authors":"Gunjan Saluja, Lavanya Gandepalli, Vasudha Garg, Rebika Dhiman, Rohit Saxena, Swati Phuljhele","doi":"10.1080/2576117X.2026.2716549","DOIUrl":"10.1080/2576117X.2026.2716549","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the diagnostic accuracy of the Melbourne Rapid Fields (MRF) tablet perimeter in comparison with the Humphrey Visual Field (HVF) analyzer in detecting visual field defects in patients with neuro-ophthalmic conditions.</p><p><strong>Methods: </strong>This prospective observational study was conducted on 15 patients with neuro-ophthalmic conditions showing confirmed visual field defects on HVF. Each patient also underwent visual field testing using the MRF application on an iPad. Test results were reviewed by both masked and unmasked observers to classify defect patterns. Agreement between instruments and observers, test duration, and diagnostic value were analyzed.</p><p><strong>Results: </strong>29 eyes were tested in total. The mean age of the subjects was 34.8 ± 1.86 years, and 73.3% were male. Diagnoses included suprasellar masses, traumatic optic neuropathy, occipital infarcts, optic neuritis, toxic optic neuropathy, and radiation-induced optic neuropathy. There was high agreement of visual field defect patterns between MRF and HVF. The mean test duration for HVF and MRF was 268.86 s and 238.38 s respectively (<i>p</i> < .001). Cohen's kappa coefficient demonstrated substantial interobserver concordance.</p><p><strong>Conclusions: </strong>MRF perimetry provides results comparable to HVF in detecting neuro-ophthalmic visual field defects and offers a time-efficient and a cost-effective method, particularly useful for bedside or remote screening.</p>","PeriodicalId":37288,"journal":{"name":"Journal of Binocular Vision and Ocular Motility","volume":" ","pages":"52-57"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Different Laterality in Hereditary Monozygotic Twins with Duane Retraction Syndrome Type I: A Case Report.","authors":"Reza Jafari, Anousheh Ghaffari, Alireza Razavi, Zahra Heidari","doi":"10.1080/2576117X.2026.2640745","DOIUrl":"10.1080/2576117X.2026.2640745","url":null,"abstract":"<p><strong>Background: </strong>Simultaneous contraction of the medial and lateral rectus muscles results in Duane Retraction Syndrome (DRS). The presence of a familial pattern in some cases suggests an autosomal dominant mode of transmission. Despite the variable presentation of this syndrome, its cause remains unclear. Describing the potential factors contributing to DRS in monozygotic twins may be effective in explaining its etiology.</p><p><strong>Case presentation: </strong>We report a unique case of monoamniotic monozygotic twins case both 7-year-old Iranian girls with DRS type I, inherited from their 36-year-old father with DRS type III. There was no clinical manifestation of DRS in the 38-year-old Iranian mother. One twin exhibited bilateral DRS, whereas the other manifested DRS exclusively in the right eye. In contrast, their father had DRS limited to the left eye. The unique laterality discordance in monozygotic twins emphasizes the role of gene expression patterns in the variability of DRS. These findings highlight the complex nature of clinical expression of DRS. Furthermore, we recognize the need to consider additional factors, such as placental dynamics, the environment, epigenetic modifications, and vascular development, for a comprehensive understanding of this condition.</p><p><strong>Conclusion: </strong>While genetic factors may play a fundamental role in understanding DRS in twins, it is important to consider the interaction of placental, environmental, epigenetic, and vascular developmental factors for a comprehensive approach.</p>","PeriodicalId":37288,"journal":{"name":"Journal of Binocular Vision and Ocular Motility","volume":" ","pages":"33-37"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kai Xu, Yidan Zhang, Wangyi Fang, Qingyu Liu, Zian Hu, Wen Li, Kourosh Shahraki, Donny W Suh, Tong Qiao
{"title":"Clinical Characteristics and Surgical Outcomes of Acute Acquired V-Pattern Esotropia: A Comparative Study Highlighting Novel Demographics, Refractive Profiles, and Superior Sensory Recovery.","authors":"Kai Xu, Yidan Zhang, Wangyi Fang, Qingyu Liu, Zian Hu, Wen Li, Kourosh Shahraki, Donny W Suh, Tong Qiao","doi":"10.1080/2576117X.2026.2638594","DOIUrl":"10.1080/2576117X.2026.2638594","url":null,"abstract":"<p><strong>Purpose: </strong>To characterize the clinical profile, surgical outcomes, and prognostic factors of acute acquired V-pattern esotropia (AAVE), a rare, understudied subtype of strabismus, and compare its features to classic V-pattern esotropia (VE).</p><p><strong>Methods: </strong>In this retrospective cohort study, 37 AAVE and 39 VE patients underwent standardized surgical correction. Outcomes included alignment, stereoacuity, and refractive status.</p><p><strong>Results: </strong>Compared to VE, AAVE patients were significantly older at onset (8.5 vs. 3.0 years, <i>p</i> < .0001), exhibited milder hyperopia (+0.68D vs. +2.90D, <i>p</i> < .0001), and presented with larger preoperative esodeviations (44.1 vs. 36.8 PD, <i>p</i> = .0109). After 1-year follow-up, stereoacuity recovery was superior in AAVE patients (80.8% achieving good stereoacuity vs. 37.9% in VE; <i>p</i> = .0127), though surgical success rates did not differ significantly (73.0% vs. 64.1%, <i>p</i> = .4057).</p><p><strong>Conclusion: </strong>AAVE represents a distinct diagnostic entity marked by acute onset, older age, and superior postoperative sensory recovery. Its unique refractive profile and association with modern near-work stressors raises consideration of modern visual stressors in pattern strabismus, supporting consideration of early surgical intervention to maximize binocular potential. These findings suggest that AAVE represents an important subtype in pediatric ophthalmology, supporting the need for updated clinical guidelines.</p>","PeriodicalId":37288,"journal":{"name":"Journal of Binocular Vision and Ocular Motility","volume":" ","pages":"19-26"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147366422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Unilateral Medial Rectus Recession for Correction of 20 to 30 ∆ of Esotropia.","authors":"Rehab Rashad Kassem","doi":"10.1080/2576117X.2026.2682642","DOIUrl":"10.1080/2576117X.2026.2682642","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the effect of unilateral medial rectus (MR) recession for the correction of 20 to 30 ∆ of esotropia.</p><p><strong>Methods: </strong>Pediatric patients with esotropia (ET) with a surgical target of 20 to 30 prism diopters (∆) were included in a prospective study to determine the effect of unilateral MR recession. The surgical target angle was calculated as the average of the distant angle with glasses and near without glasses, or the average of distant and near angles without glasses (if non-significant refractive error), or the average of near angles with and without glasses (if ET was measured using the modified Krimsky test). The study endpoint was the last follow-up visit, conducted at least 3 months postoperatively. A successful motor outcome was defined as orthotropia or a horizontal tropia of 10∆ or less at distance and near.</p><p><strong>Results: </strong>The study included 21 patients, 1 to 12 years of age. Patients were followed up for 3 to 43 (mean+/-SD 12.5+/-10.6) months. A successful outcome was achieved in 85.7%, with no correlation to the surgical target angle or the amount of recession (<i>p</i> > .05). The 14.3% failure rate was attributed to undercorrections. Persistent lateral incomitance was observed in 10.5% of cases and was not correlated with the surgical target angle or the amount of recession (<i>p</i> > .05). Persistent limited ductions were mild (-1).</p><p><strong>Conclusions: </strong>This prospective study of pediatric patients showed that unilateral MR recession is a reasonable surgical approach for treating esotropia of 20-30 ∆, with small rates of undercorrection and duction limitation, and no overcorrection.</p>","PeriodicalId":37288,"journal":{"name":"Journal of Binocular Vision and Ocular Motility","volume":" ","pages":"27-32"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Raghul Gurunathan, Praveen Kumar P, Amit Bhowmick, Hennaav Kaur Dhillon
{"title":"Beyond the Classic Near Triad: Diagnostic Insights from a Case of Accommodative Spasm.","authors":"Raghul Gurunathan, Praveen Kumar P, Amit Bhowmick, Hennaav Kaur Dhillon","doi":"10.1080/2576117X.2026.2680774","DOIUrl":"10.1080/2576117X.2026.2680774","url":null,"abstract":"<p><strong>Background: </strong>Accommodative spasm (AS) is an involuntary condition characterized by excessive contraction of the ciliary muscle, leading to exaggerated accommodative response and fluctuating refractive error. The reported prevalence of accommodative spasm ranges from 2.6% in an Indian clinic cohort to 37.19% in Chinese school children. Since the COVID-19 pandemic, accommodative spasm has been reported in 20% of symptomatic patients associated with increased near work and digital screen exposure. It often presents with headache, photophobia, blurred distance vision, and eye strain. This case report describes bilateral accommodative spasm in a 14-year-old female who presented with blurred distance vision in left eye and headaches.</p><p><strong>Case presentation: </strong>Best-corrected visual acuity was 20/20 in the right eye and 20/400 in the left eye; near acuity was N6 in both eyes. Objective refraction using an open-field autorefractor (WAM-5500) showed fluctuating myopia. Retinoscopy revealed a vacillating reflex, and a lead of accommodation on dynamic retinoscopy suggesting accommodative instability, which was further confirmed by excessive accommodative responses measured using open-field autorefractor. Baseline ocular biometry revealed axial length within the normal range, increased lens thickness, and reduced anterior chamber depth. The patient was treated with 1% atropine sulfate eye ointment, administered twice daily for three days. Cycloplegic refraction on day four showed resolution of the spasm with a stable retinoscopic reflex.</p><p><strong>Results: </strong>After a 21-day atropine washout, repeat retinoscopy confirmed the absence of accommodative instability. Post-mydriatic ocular biometry showed no change in axial length but significant improvements in lens thickness and anterior chamber depth.</p><p><strong>Conclusion: </strong>This case highlights the potential role of objective ocular biometry as an adjunctive tool in accommodative spasm, providing additional structural insights that may aid clinical diagnosis and treatment monitoring.</p>","PeriodicalId":37288,"journal":{"name":"Journal of Binocular Vision and Ocular Motility","volume":" ","pages":"38-42"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clinical Profile and Surgical Outcomes of Bilateral Duane Syndrome with Exotropia.","authors":"Adeline Shona Lasrado, Goura Chattannavar, Ramesh Kekunnaya","doi":"10.1080/2576117X.2026.2627033","DOIUrl":"10.1080/2576117X.2026.2627033","url":null,"abstract":"<p><strong>Objective: </strong>To study the clinical profile and surgical outcomes of patients with bilateral Duane syndrome with exotropia.</p><p><strong>Methods: </strong>The records of all consecutive patients diagnosed with bilateral Duane syndrome with exotropia in primary gaze (2010-2024) were reviewed. Patient demography, age at presentation, and type of Duane syndrome were studied in the clinical profile. The pre-operative and post-operative details of angle of deviation, abnormal head posture, horizontal ocular ductions, grade of globe retraction, and overshoot were evaluated for the surgical outcomes.</p><p><strong>Results: </strong>Forty-five patients (male, 51%) were diagnosed with bilateral Duane syndrome with exotropia, of which 38% underwent surgical correction. The mean age at presentation was 18.06 ± 12.08 years. Of the total, 37% were emmetropic and 29% amblyopic. Bilateral type 3 Duane syndrome (49%) was the most common presentation. The mean pre-operative deviation for distance and near was 29.84 ± 17.73Δ and 32.49 ± 18.44Δ, respectively. The mean change in angle of deviation post-operatively for distance and near was 23 ± 5Δ and 26 ± 5Δ, respectively. The average angle of deviation at the final follow-up for distance was 8 ± 12Δ and near 12 ± 12Δ. Surgical success for primary position deviation, abnormal head posture, globe retractions, and overshoots was achieved in 59%, 86%, 57%, and 50% patients, respectively.</p><p><strong>Conclusion: </strong>Bilateral type 3 is the most common bilateral Duane syndrome with exotropia. Individualized surgical management (algorithm) ensures optimal alignment and head posture correction.</p>","PeriodicalId":37288,"journal":{"name":"Journal of Binocular Vision and Ocular Motility","volume":"76 1","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147469288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}