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In an attempt to evaluate the response to surgical treatment, the surgical outcome of 16 patients with Duane's retraction syndrome (DRS) was investigated. Single horizontal rectus muscle recession, transposition of vertical recti and recession of both horizontal recti were carried out. In one of the four patients with significant globe retraction, Y splitting of the lateral rectus muscle was added to the procedure to overcome the cosmetically unacceptable upshoot. Single horizontal muscle recession surgery was effective in reducing the abnormal head posture and the deviation in primary position. The results of both horizontal recti recession were not so predictable in reducing globe retraction. Recession of both horizontal recti was ineffective in vertical DRS. It is suggested that the variability of surgical outcome in DRS may be related to the different innervational patterns and mechanical factors.

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