synergistic divergence: a rare variant of duane's syndrome

purpose: to report and review a rare variant of duane's syndrome named synergistic divergence and its surgical results. patient and findings: a 16-year-old girl presented with left face turn and reduced vision in both eyes. best corrected vision was od: 3/10 and os: 10/10. there was severe adduction deficiency of the re with simultaneous abduction of the re in left gaze. she had xt= 35 in primary position. she underwent subtotal rlr extirpation with a diagnosis of synergistic divergence. xt, abnormal head posture, and simultaneous divergence improved satisfactorily. conclusion: lr extirpation should be considered in the surgical planning of synergistic divergence. in the present case this procedure satisfactorily improved symptoms.