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

Lee, Byoung Hee; Choi, Tae Ho; Choi, Yun Young

Case Report

Journal of the Korean Ophthalmological Society 2004;45(11):1932-1938.
Published online November 1, 2004.

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

Byoung Hee Lee, Tae Ho Choi, Yun Young Choi

Department of Ophthalmology, Daegu Fatima Hospital, Daegu, Korea. eye9407@yahoo.co.kr

두부외상 후 발생한 양측 핵간안근마비에서 조정수술 1예

이병희 ( Byoung Hee Lee ) , 최태호 ( Tae Ho Choi ) , 최윤영 ( Yun Young Choi )

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.

Key Words: Adjustable surgery;Head trauma;Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO)