A Case of Adjustable Surgery in Wall-eyed Bilateral Internuclear Ophthalmoplegia after Head Trauma

ABSTRACT

PURPOSE: Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) is a variation of bilateral internuclear ophthalmoplegia (Bilateral INO) that has profound exotropia in primary position. Head trauma is a rare cause in WEBINO. We report a case of WEBINO after head trauma which was not improved for 9 months and underwent extraocular muscle surgery with adjustable suture. METHODS: A 39-year-old man was referred to the department of ophthalmology for diplopia after head trauma from the department of neurosurgery. He was profoundly exotropic in the primary position and hads bilateral marked limitation of adduction with contralateral abducting nystagmus. There was no improvement even 9 months after the injury, so he underwent extraocular muscle surgery with adjustable suture. RESULTS: At postoperative 6 months, the patient showed orthophoria in the primary position and ocular motility was increased in adduction. There was no diplopia with a large area of binocular single vision in the primary position. CONCLUSIONS: Because of the disruption of normal ocular motor control in WEBINO, the effect of standard muscle surgery is unpredictable. Adjustable surgery is considerable as a useful technique because it is important in making accurate postoperative alignment, especially for diplopia.