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Two-staged Surgical Correction for Large Angle Exotropia in Wall-eyed Bilateral Internuclear Ophthalmoplegia
Ann Optom Contact Lens 2019;18:61-65
Published online June 25, 2019
© 2019 The Korean Optometry & Contact Lens Study Society

Sun Kyoung Park, MD, Hee Jong Shin, MD, Jun Myeong Yun, MD, Hye Bin Yim, MD, PhD

Department of Ophthalmology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
Correspondence to: Hye Bin Yim, MD, PhD
Department of Ophthalmology, Incheon St. Mary’s Hospital, #56 Dongsu-ro, Bupyeong-gu, Incheon 21431, Korea
Tel: 82-32-280-5110, Fax: 82-32-510-5833
E-mail: yiimhb@naver.com
Received April 8, 2019; Revised May 23, 2019; Accepted June 3, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Purpose: We report a case of two-staged adjustment surgery in wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) with severe bilateral lateral deviation after attack of cerebrovascular infarction.
Case summary: A 67-year-old male patient diagnosed with acute intracranial hemorrhage was referred to department of ophthalmology due to severe diplopia that worsened during horizontal gaze of both eyes. On the alternate prism cover test, he had a severe exotropia of about 90 prism diopters (PD) at primary position, and -4 degrees of eye movement disorder were identified on both eyes. Brain magnetic resonance imaging showed a high-signal ischemic infarction on midbrain and pons. Nine months after the initial examination, we performed two-staged adjustment surgery of recession of lateral rectus muscle with resection of medial rectus muscle in both eyes. After 3 months of the two-staged adjustment surgery, he had an exotropia of about 2 PD at primary position on far alternate prism cover test and straight at primary position on near alternate prism cover test.
Conclusions: We report a case of two-staged adjustment surgery in WEBINO with severe bilateral lateral deviation showed good results.
Keywords : Diplopia; Wall-eyed bilateral internuclear ophthalmoplegia


June 2019, 18 (2)