Wall-Eyed Bilateral Internuclear Ophthalmoplegia (WEBINO)

Example of patient with horizontal binocular diplopia. Demonstration of exam, which shows alternating exotropia in cover test. As patient follows object, right eye does not pass the midline as the object moves to the left, while left eye go slightly past the midline, but does not abduct completely. Also, abducting eye occasionally shows some abduction nystagmus. Shifts in distance of gaze reveal a lag in adduction. Patient is able to achieve occasional convergence