WEBINO Syndrome Secondary to Multiple Sclerosis Treated Surgically

WEBINO syndrome (wall-eyed bilateral internuclear ophthalmoplegia) is a rare neuro-ophthalmological disorder characterized by bilateral adduction deficit, abducting nystagmus, large-angle exotropia in the primary gaze position, and impaired convergence, secondary to bilateral lesion of the medial longitudinal fasciculus. We report the case of a 35-year-old woman with multiple sclerosis who consulted for persistent horizontal binocular diplopia. Examination revealed alternating exotropia of 50 prism diopters with bilateral adduction limitation, abducting nystagmus, and absence of convergence, consistent with WEBINO syndrome. After one year of clinical stability without improvement in deviation, strabismus surgery was performed, consisting of bilateral lateral rectus recession and bilateral medial rectus resection. Postoperatively, functional orthotropia was achieved, with resolution of diplopia and improvement in both adduction and convergence. Strabismus surgery represents an effective therapeutic option in selected patients with stable deviation and disabling diplopia.