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Abstract
The purpose of this study is to describe the surgical management of internuclear ophthalmoplegia (INO) and its variants. This is a retrospective, noncomparative, observational study of 15 surgical procedures on thirteen patients with symptoms attributed to INO which were conducted between December 1993 and October 2006. Surgical management was decided on the results of orthoptic measurements and tailored to each individual patient. In this group of 13 patients there were 4 cases of ‘wall-eyed’ bilateral INO (WEBINO) syndrome, 6 cases of bilateral INO with intact convergence and 3 cases of unilateral INO. The commonest indication for surgery was diplopia, either in primary or immediate lateral gaze, in 12 cases. The mean length of symptoms was 61 months (range 12 to 180). The mean angle of deviation pre-operatively was 25.7 prism diopters (PD) base-in (BI). Bilateral lateral rectus (LR) recession was used in 9 cases. Unilateral LR recession combined with medial rectus (MR) resection was performed in 2 cases. The remaining 4 cases had a unilateral LR recession. The mean post-operative angle of deviation was 11.6PD BI. The mean change in deviation was 14.6 PD. There were no intra- or post-operative surgical complications. Incomplete symptomatic relief in 2 patients necessitated a second surgical procedure. At final review all patients were asymptomatic. Surgery is an option that should be considered in all patients with an incompletely resolved INO. All our patients had complete relief from their symptoms. In the hands of an experienced strabismus surgeon, the surgery is routine. We show that patients who are willing for surgical intervention wait an average of 5 years for surgery and could be offered surgery more quickly.