Convergence Exercises for Convergence Insufficiency Type Exotropia in Bilateral Internuclear Ophthalmoplegia

Authors

  • 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"

DOI:

https://doi.org/10.12974/2311-8687.2023.11.11

Keywords:

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

Abstract

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.

References

Bennetto L, Lueck CJ. Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO): what does it mean to be wall-eyed? Practical Neurology 2022; 22: 4-5. https://doi.org/10.1136/practneurol-2021-003157

Leigh RJ, Zee DS. The neurology of eye movements. 5th edn. Oxford: Oxford University Press, 2015: 863-75. https://doi.org/10.1093/med/9780199969289.001.0001

Kim JS. Internuclear ophthalmoplegia as an isolated or predominant symptom of brainstem infarction. Neurology 2004; 62: 1491-6. pmid: http: //www.ncbi.nlm.nih.gov/pubmed/15136670. https://doi.org/10.1212/01.WNL.0000123093.37069.6D

Johnston JL, Sharpe JA. The WEMINO syndrome - wall-eyed monocular internuclear ophthalmoplegia: and oculographic and neuro-pathologic characterization [Abstract]. Neurology 1994; 44: A311

McGettrick P, Eustace P. The w.e.b.i.n.o. syndrome, Neuro-Ophthalmology 1985; 5: 109-15. https://doi.org/10.3109/01658108509014426

Chen C-M, Lin S-H. Wall-eyed bilateral internuclear ophthalmoplegia from lesions at different levels in the brainstem. J Neuroophthalmol 2007; 27: 9-15. pmid: http: //www.ncbi.nlm.nih.gov/pubmed. https://doi.org/10.1097/WNO.0b013e3180334e8d

Uzawa A, Takeda Y, Kuwabara S. Wall-eyed bilateral internuclear ophthalmoplegia by ischemic stroke: case report and literature review. Neurologist 2020; 25: 82-4. pmid: http: //www.ncbi.nlm.nih.gov/pubmed/32358467. https://doi.org/10.1097/NRL.0000000000000271

Brazis PW, Masdeu JC, Biller J. Localization in clinical neurology. 5th edn. Lippincott Williams & Wilkins, Philadelphia, 2007: 229

Wu YT, Cafiero-Chin M, Marques C. Wall-eyed bilateral internuclear ophthalmoplegia: review of pathogenesis, diagnosis, prognosis, and management. Clin Exp Optom 2015; 98: 25-30. pmid: http: //www.ncbi.nlm.nih.gov/pubmed/25308307. https://doi.org/10.1111/cxo.12200

Murthy R, Dawson E, Khan S, Adams GG, Lee J. Botulinum toxin in the management of internuclear ophthalmoplegia. J AAPOS 2007; 11: 456-459. https://doi.org/10.1016/j.jaapos.2007.03.005

Roper-Hall G, Cruz OA, Chung SM. Results of extraocular muscle surgery in WEBINO bilateral internuclear ophthalmoplegia patients. J AAPOS 2008; 12: 277-281. https://doi.org/10.1016/j.jaapos.2007.11.013

Adams WE, Leavitt JA, Holmes JM. Strabismus surgery for internuclear ophthalmoplegia with exotropia in multiple sclerosis. J AAPOS 2009; 13: 13-15. https://doi.org/10.1016/j.jaapos.2008.08.008

Gallaway M, Scheiman M, and Mitchell GL. "Vision Therapy for Post-Concussion Vision Disorders," Optom. Vis. Sci., 2017; 94(1): 68-73. https://doi.org/10.1097/OPX.0000000000000935

Downloads

Published

2023-08-09

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. https://doi.org/10.12974/2311-8687.2023.11.11

Issue

Section

Articles