Internuclear Ophthalmoplegia as a Presenting Neuro-ophthalmic Manifestation of Multiple Sclerosis

Melinda Ryan, BappSc (Hons) DOBA
Julia Kelly, Assoc Dip (Orth) DOBA

Multiple Sclerosis is a disease which has well documented neuro-ophthalmic manifestations of optic neuritis and Internuclear ophthalmoplegia. Optic neuritis is characterised by subacute painful visual loss, reduced colour vision, contrast sensitivity and visual field loss. A case history of multiple sclerosis in a 25 year old female is presented. The presenting symptoms were blurred vision and dizziness on laevoversion and tingling in the left foot. Examination of ocular movements demonstrated limitation of right abduction and left abduction nystagmus with diplopia on laevoversion, consistent with unilateral right Internuclear ophthalmoplegia. Although a diagnosis of optic neuritis was eventually made, this was not consistent with the presenting symptoms. This case highlights the importance of a full orthoptic investigation of neuro-ophthalmic patients.