Purpose: To describe the clinical features of patients with Duane retraction syndrome (DRS) and evaluate the outcomes of surgical approaches based on the characteristics of each patient. Methods: The records of 38 Caucasian subjects with DRS were retrospectively reviewed. The patients were classified as type I, II, or III based on the Huber Classification. Ten patients underwent unilateral medial rectus (MR) recession due to abnormal head posture (AHP) and/or esotropia. Four patients underwent Y-splitting and recession of the lateral rectus (LR) with MR recession due to AHP and/or esotropia, upshoot, and globe retraction. Results: There was a preponderance of unilaterality, female gender, left eye, type I, orthotropia, upshoot, and low refractive error. All patients demonstrated globe retraction and fissure narrowing. AHP was only present in unilateral cases. Nine patients had amblyopia. More than half of the patients over 5 years of age had decreased stereopsis. MR recession decreased AHP to less than 8 degrees in all patients. Y-splitting and recession of the LR eliminated upshoot in all four patients. One patient who underwent an 8-mm MR recession demonstrated -2 adduction limitation. Conclusions: The DRS patients in our study demonstrated features that are consistent with previous reports in the literature. This study emphasizes the need to consider disease classification in the surgical management of DRS patients.