Bilateral Duane's syndrome associated with crocodile tears

Duane's retraction syndrome is a relatively common abnormality of ocular mobility. Classically, it includes restriction of abduction of one eye and marked retraction of the affected eye in an attempted adduction with narrowing of the palpebral aperture. In less than 20% of the cases, both eyes may be affected. Crocodile tears, or a paradoxical gustatory lacrimal reflex, is rare as a congenital anomaly. Until now only 11 cases have been reported in the literature, four of them associated with Duane's retraction syndrome. We wish to add an additional case of bilateral crocodile tears associated with bilateral Duane's syndrome. The rare association of two syndromes of paradoxical innervation, bilateral Duane's retraction syndrome and congenital crocodile tears, is presented. This association assumes a central localization to explain both anomalies.