Which of the following is NOT true regarding Duane's Retraction syndrome?

• A. Patients typically present with exotropia in primary gaze.
• B. Type 1 = Limited abduction
• C. Type 2 = Limited adduction
• D. Type 3 = Limited abduction and adduction

Answer: (A)

Duane retraction syndrome is a congenital misinnervation of the lateral rectus, usually with some aberrant innervation from the oculomotor nerve. The result is limited horizontal gaze and globe retraction with adduction, often with palpebral fissure narrowing and sometimes upshoots or downshoots on adduction. The condition is categorized into three types by which movement is limited: abduction, adduction, or both.

What the question hinges on is that primary gaze alignment is not a single fixed pattern across all patients. While one subtype often shows exotropia in primary position, other subtypes frequently have esotropia or may be near orthophoric in primary gaze. Saying that patients “typically present with exotropia in primary gaze” overgeneralizes across all types, which is why that statement is not true.

So, the NOT-true statement is the idea that exotropia in primary gaze is the typical presentation for all Duane syndrome cases. The other type-specific patterns align with what is observed clinically: abduction is predominantly limited in the first type, adduction in the second, and both directions in the third, with primary-position deviations varying accordingly.