Convergence Exercises for Convergence Insufficiency Type Exotropia in Bilateral Internuclear Ophthalmoplegia

Purpose; To report a case of successfully treated convergence insufficiency type exotropia (CI-XT) in the context of bilateral internuclear ophthalmoplegia (BINO) using only convergence exercises. Observations; A 17-year-old male with a history of a resected posterior fossa pilocytic astrocytoma presented with constant diplopia since the craniotomy. Patient and his parents were adamant in pursuing surgical treatment for his new onset strabismus. With appropriate counseling and management with convergence exercises only, the CI-IXT was successfully treated without surgery over the course of two years. Conclusion and Importance; We present a non-invasive approach to the treatment of CI-IXT in the context of a BINO, also known as wall-eyed BINO (WEBINO). This approach should be considered before any surgical intervention, especially if prism is unable to successfully neutralize diplopia for any extended period of time.