Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO): what does it mean to be wall-eyed?

Martin Lubow (1931–2015)1 is credited with coining the term ‘wall-eyed bilateral internuclear ophthalmoplegia’ (WEBINO).2 Most readers will be familiar with internuclear ophthalmoplegia (INO) and the fact that it can occur bilaterally. So why is WEBINO, as in the case presented by Chen3 in this issue of Practical Neurology, special?

INO is caused by damage to the medial longitudinal fasciculus (MLF). This interrupts the nerve fibres connecting the sixth and third nerve nuclei, which facilitate conjugate horizontal eye movement. A unilateral INO causes slowing, or absence, of adduction of the ipsilateral eye and, usually, gaze-evoked nystagmus of the abducting, contralateral eye during attempted contralateral gaze. Interestingly, adduction is not infrequently preserved in the context of convergence.4 Because these are not the only fibres that travel in the MLF, there may be additional abnormalities due to interruption of the vestibular/otolithic pathways, such as skew deviation…

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