Recession of both horizontal recti muscles in Duane's retraction syndrome with elevation and depression of the adducted eye.

Upshoot and downshoot of the adducted eye in Duane's retraction syndrome is thought to be caused by a bridle effect of the co-contracting horizontal recti muscles. A recession of both of these muscles transposes their insertions posteriorly in relation to the center of rotation of the globe, which reduces the bridle effect and decreases the upshoot and downshoot. An 11-year-old girl had Duane's retraction syndrome type III and upshoot and downshoot of the left eye. The left lateral rectus muscle was recessed 8 mm and the left medial rectus muscle 6 mm. At last examination 10 1/2 months postoperatively, the upshoot and downshoot on attempted adduction was no longer present.