Duane Syndrome (DS) in its classic form is characterized by congenital onset limitation of horizontal eye movements with globe retraction and narrowing of palpebral fissure (PF) on adduction.[1] Despite significant limitation of horizontal ocular motility, the ocular deviation in primary position is lesser than would occur in muscle palsies.[1] Upshoot or downshoot in adduction is commonly associated.[1] A congenital sixth nerve or congenital lateral rectus (LR) palsy is rare and may be related to birth trauma.[2] The title of a Souza-Dias publication stated: “Congenital VIth nerve is Duane’s Syndrome until disproven”, and it also reflects the rarity of congenital sixth nerve paresis.[3,4] Here, we present a case of an adolescent, with a congenital sixth nerve palsy presenting as Type I DS.[5] To our knowledge, a similar case has not been reported in literature (Medline search). Our patient was successfully managed with a single muscle surgery.

Duane Syndrome (DS) in its classic form is characterized by congenital onset limitation of horizontal eye movements with globe retraction and narrowing of palpebral fissure (PF) on adduction.[1] Despite significant limitation of horizontal ocular motility, the ocular deviation in primary positio...