<prompt> Weakness of both Adduction and abduction is seen in:Duanes retraction syndrome type 1Duanes retraction syndrome type 2Duanes retraction syndrome type 3Double elevator palsy  <response>: Ans. c. Duanes retraction syndrome type 3 Ref: Kanski 5e p548; Khurana 5e p355Weakness of both adduction and abduction is seen in Duanes retraction syndrome type 3.Duanes Retraction SyndromeCongenital strabismus that is usually caused by failure of normal development of the abducens nerve.Absence of the abducens nerve and fascicle with anomalous innervation of the lateral rectus muscle by the oculomotor nervePatients may have esotropia or esotropiaMostly unilateral, commonly affecting the left eye more than rightCharacteristic feature of Duanes Retraction SyndromeRetraction of the globe and narrowing of the palpebral fissure during attempted adductionQ.This feature is caused by the simultaneous contraction of the medial and lateral rectus muscle that occurs during attempted adductionQ.Duanes Retraction SyndromeType lEsotropic Duanes SyndromeType IIExotropic Duanes SyndromeType III Most common typeQ Absence or limitation of abduction and normal adductionQ Least common typeQ Limited adduction with normal abductionQ. Limitation of both adduction and abductionQDouble Elevator Palsy:All horizontal gaze movements are normal.Double elevator palsy mono ocular elevator palsy is caused by tight oblique contracted inferior rectus muscle or hypoplasticineffective superior rectus muscle. 