Convergence Exercises for Convergence Insufficiency Type Exotropia in Bilateral Internuclear Ophthalmoplegia


  • Edward Kuwera The Wilmer Eye Institute, Department of Pediatric Ophthalmology and Adult Strabismus, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
  • Shreya Hariharakumar "Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA" & "Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA"



Strabismus, Internuclear ophthalmoplegia, Wall-eyed internuclear ophthalmoplegia, INO, BINO, WEBINO, Exotropia


Purpose; To report a case of successfully treated convergence insufficiency type exotropia (CI-XT) in the context of bilateral internuclear ophthalmoplegia (BINO) using only convergence exercises.

Observations; A 17-year-old male with a history of a resected posterior fossa pilocytic astrocytoma presented with constant diplopia since the craniotomy. Patient and his parents were adamant in pursuing surgical treatment for his new onset strabismus. With appropriate counseling and management with convergence exercises only, the CI-IXT was successfully treated without surgery over the course of two years.

Conclusion and Importance; We present a non-invasive approach to the treatment of CI-IXT in the context of a BINO, also known as wall-eyed BINO (WEBINO). This approach should be considered before any surgical intervention, especially if prism is unable to successfully neutralize diplopia for any extended period of time.


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How to Cite

Kuwera, E. ., & Hariharakumar, S. . (2023). Convergence Exercises for Convergence Insufficiency Type Exotropia in Bilateral Internuclear Ophthalmoplegia. International Journal of Pediatrics and Child Health, 11, 65–68.