A newborn has bilateral inability to abduct either eye beyond the midline, bilateral facial weakness with an expressionless face, intact vertical gaze, and clubfoot deformity. The most likely diagnosis is:

• A Congenital bilateral sixth nerve palsy with facial diplegia (Moebius syndrome) ✓
• B Duane retraction syndrome type III
• C Infantile esotropia with cross-fixation
• D Congenital fibrosis of the extraocular muscles

Explanation

Moebius syndrome combines congenital nuclear aplasia of the sixth and seventh cranial nerves, producing limited abduction and a mask-like facies, often with systemic anomalies such as clubfoot. Vertical gaze is spared, which helps separate it from diffuse congenital fibrosis of the extraocular muscles. Duane syndrome shows globe retraction and palpebral fissure narrowing on attempted adduction, findings absent here.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.