Conservative and Surgical Management of Unilateral and Bilateral Internuclear Ophthalmoplegia (INO)—A Retrospective Analysis
Aim: To report the outcomes of the natural progression and ophthalmic treatment of patients reviewed in a tertiary hospital trust with unilateral or bilateral internuclear ophthalmoplegia. Method: A retrospective case note analysis was performed and 33 patients diagnosed with unilateral or bilateral...
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| Format: | Article |
| Language: | English |
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White Rose University Press
2022-11-01
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| Series: | British and Irish Orthoptic Journal |
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| Online Access: | https://www.bioj-online.com/articles/280 |
| _version_ | 1811187475868024832 |
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| author | Joshua Simmons Martin Rhodes |
| author_facet | Joshua Simmons Martin Rhodes |
| author_sort | Joshua Simmons |
| collection | DOAJ |
| description | Aim: To report the outcomes of the natural progression and ophthalmic treatment of patients reviewed in a tertiary hospital trust with unilateral or bilateral internuclear ophthalmoplegia. Method: A retrospective case note analysis was performed and 33 patients diagnosed with unilateral or bilateral internuclear ophthalmoplegia (INO) were identified. The diagnosis, aetiology, presence of diplopia, ophthalmic management options and progression were recorded and analysed. This included both conservative and surgical management. Results: The most common aetiologies of INO within this cohort were stroke/ischaemic (69.7%) and multiple sclerosis (MS) (30.3%). Unilateral INO was more prevalent than bilateral INO, with 20 cases (60.6%) compared to 13 cases (39.4%), respectively. A higher proportion of unilateral INO were attributed to stroke (90%) whilst a higher proportion of bilateral INO were attributed to MS (61.5%). The most prescribed management at primary assessment was occlusion (45.5%) and prisms (24.2%). Some patients required no orthoptic intervention (30.3%). Two patients had surgical management of strabismus secondary to bilateral INO. Conclusion: Occlusion was the most common form of management for symptomatic relief of diplopia. Patients who presented at the first visit with no symptoms were unlikely to need any orthoptic intervention. Of the two patients who went on to require surgical intervention, restoration of binocular single vision (BSV) was achieved post-operatively with the use of a Fresnel prism. However, the differences in both surgical technique and number of surgeries required make this difficult to generalise. Additional research is needed to further explore the surgical management of INO. |
| first_indexed | 2024-04-11T14:04:07Z |
| format | Article |
| id | doaj.art-c6fc8a03aa80418f86091ea6aedd35a1 |
| institution | Directory Open Access Journal |
| issn | 2516-3590 |
| language | English |
| last_indexed | 2024-04-11T14:04:07Z |
| publishDate | 2022-11-01 |
| publisher | White Rose University Press |
| record_format | Article |
| series | British and Irish Orthoptic Journal |
| spelling | doaj.art-c6fc8a03aa80418f86091ea6aedd35a12022-12-22T04:20:00ZengWhite Rose University PressBritish and Irish Orthoptic Journal2516-35902022-11-0118110.22599/bioj.280243Conservative and Surgical Management of Unilateral and Bilateral Internuclear Ophthalmoplegia (INO)—A Retrospective AnalysisJoshua Simmons0Martin Rhodes1Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation TrustRoyal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation TrustAim: To report the outcomes of the natural progression and ophthalmic treatment of patients reviewed in a tertiary hospital trust with unilateral or bilateral internuclear ophthalmoplegia. Method: A retrospective case note analysis was performed and 33 patients diagnosed with unilateral or bilateral internuclear ophthalmoplegia (INO) were identified. The diagnosis, aetiology, presence of diplopia, ophthalmic management options and progression were recorded and analysed. This included both conservative and surgical management. Results: The most common aetiologies of INO within this cohort were stroke/ischaemic (69.7%) and multiple sclerosis (MS) (30.3%). Unilateral INO was more prevalent than bilateral INO, with 20 cases (60.6%) compared to 13 cases (39.4%), respectively. A higher proportion of unilateral INO were attributed to stroke (90%) whilst a higher proportion of bilateral INO were attributed to MS (61.5%). The most prescribed management at primary assessment was occlusion (45.5%) and prisms (24.2%). Some patients required no orthoptic intervention (30.3%). Two patients had surgical management of strabismus secondary to bilateral INO. Conclusion: Occlusion was the most common form of management for symptomatic relief of diplopia. Patients who presented at the first visit with no symptoms were unlikely to need any orthoptic intervention. Of the two patients who went on to require surgical intervention, restoration of binocular single vision (BSV) was achieved post-operatively with the use of a Fresnel prism. However, the differences in both surgical technique and number of surgeries required make this difficult to generalise. Additional research is needed to further explore the surgical management of INO.https://www.bioj-online.com/articles/280internuclear ophthalmoplegia (ino)wall-eyed bilateral internuclear ophthalmoplegia (webino)strabismusorthopticssurgery |
| spellingShingle | Joshua Simmons Martin Rhodes Conservative and Surgical Management of Unilateral and Bilateral Internuclear Ophthalmoplegia (INO)—A Retrospective Analysis British and Irish Orthoptic Journal internuclear ophthalmoplegia (ino) wall-eyed bilateral internuclear ophthalmoplegia (webino) strabismus orthoptics surgery |
| title | Conservative and Surgical Management of Unilateral and Bilateral Internuclear Ophthalmoplegia (INO)—A Retrospective Analysis |
| title_full | Conservative and Surgical Management of Unilateral and Bilateral Internuclear Ophthalmoplegia (INO)—A Retrospective Analysis |
| title_fullStr | Conservative and Surgical Management of Unilateral and Bilateral Internuclear Ophthalmoplegia (INO)—A Retrospective Analysis |
| title_full_unstemmed | Conservative and Surgical Management of Unilateral and Bilateral Internuclear Ophthalmoplegia (INO)—A Retrospective Analysis |
| title_short | Conservative and Surgical Management of Unilateral and Bilateral Internuclear Ophthalmoplegia (INO)—A Retrospective Analysis |
| title_sort | conservative and surgical management of unilateral and bilateral internuclear ophthalmoplegia ino a retrospective analysis |
| topic | internuclear ophthalmoplegia (ino) wall-eyed bilateral internuclear ophthalmoplegia (webino) strabismus orthoptics surgery |
| url | https://www.bioj-online.com/articles/280 |
| work_keys_str_mv | AT joshuasimmons conservativeandsurgicalmanagementofunilateralandbilateralinternuclearophthalmoplegiainoaretrospectiveanalysis AT martinrhodes conservativeandsurgicalmanagementofunilateralandbilateralinternuclearophthalmoplegiainoaretrospectiveanalysis |