JUN 05, 2013
Neuro-Ophthalmology/Orbit
This retrospective review of all pediatric cases of internuclear ophthalmoplegia (INO) seen at one university-based tertiary referral ophthalmology practice over an eight-year period found that the condition, while rare in this population, requires a full neurologic evaluation and careful follow-up to assess eye position and potentially treat amblyopia.
The study included three patients, one of whom was age 2 at diagnosis, the youngest reported case of INO. The patients all had bilateral INOs of differing etiologies: neonatal intracerebral hemorrhage, perinatal hypoxia and high-grade astrocytoma. All had multiple eye movement disorders that confounded the diagnosis of INO.
The 2-year-old, who had neonatal intracerebral hemorrhage, experienced improvement with complete resolution of INO in the left eye. However, the right eye continued to demonstrate an adduction deficit with abducting nystagmus in the left eye. During the course of follow-up, the child was treated for amblyopia of the right eye.
The authors note that the diagnosis of INO in a young child can be difficult due to the level of cooperation. Because of this, close follow-up and a conservative approach to surgery are appropriate. Treatment for amblyopia is often warranted during follow-up of these patients.