duane syndrome/6th nerve palsy

My now 5 year old son was diagnosed at 4 months of age with duane syndrome.We have been monitoring the condition yearly with his pediatric opthamologist.The last 2 visits she has said that she thinks what he has is 6th nerve palsy rather than duane syndrome because she doesn't see the characteristic retraction of the duanes eye (it's his right eye).We are concerned about the change in diagnosis because we feel that whatever he has has been there since birth.We first noticed it near 2 months of age.His dr. wants to do surgery to align his eyes as his head turn has gone from 12 degrees to near 25.I am concerned because I see that 6th nerve palsy can be related to a brain tumor.He hasn't had ANY other signs of anything being wrong other than the eye issue since birth.I am inclined to believe it is duanes but I really am not sure.I see his duane's eye get smaller than his other eye when he focuses on things.It is my understanding that a congenital 6th nerve palsy would be even more rare than duane syndrome?How important is it for us to know as his parents whether we are dealing with 6th nerve palsy or duane syndrome?I really am lost on what direction to go with things.Any advice or information would be very appreciated.

[Houman Vosoghi, MD]

I would get a second opinion in this regard to clarify.  As you said, Duane's is much more common than a congenital 6th nerve palsy and it makes a difference as to which surgery should be done in order to avoid worsening the retraction that comes with Duane's.  You have to be sure prior to proceeding with surgery.

HV

[momofmany11]

Thank you for encouraging me to get a second opinion,Dr Vosoghi.The second opinion from a different opthamologist was that my son does indeed have duane syndrome.He evidenced the retraction quite a bit the day of his appointment.The dr. does feel surgery will be of benefit at some point because he has about a 20 degree head turn.His vision is 20/20 though so now we are wondering at what point do we consider surgery since his vision is good and the duanes doesn't seem to cause him any bother at all.They would do a muscle transposition surgery.
I appreciate your advice.