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Old 07-17-2013, 06:12 PM #17
strizzlow20 strizzlow20 is offline
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Join Date: Jan 2009
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strizzlow20 strizzlow20 is offline
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Join Date: Jan 2009
Posts: 140
15 yr Member
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So I found some information below. If what I am having are too subtle to detect on an exam, I guess it's not impossible for me to have the vision issues that I am having. I read about pseudo internuclear ophthalmoplegia myasthenia gravis which can mimic true INO.

What is Internuclear Ophthalmolplegia?

Internuclear ophthalmoplegia (INO) is the classic visual problem of the eye movement system in MS and is seen in 22 percent of individuals with the disease. INO can involve abnormal movements of one or both eyes. INO is the result of an inflammatory demyelinating lesion in the pathway joining the eye muscles that allows us to move both eyes simultaneously when looking to the side. This pathway is called the medial longitudinal fasciculus (MLF), and is located in the brainstem. With an MS lesion affecting the MLF on the right side of the brainstem, the right eye can not look towards the nose (to the left), but the left eye can move out towards the left. The right eye will, in a sense, try to ‘call the other eye back’ towards the right side if gaze to the left is maintained. This will result in involuntary, rapid, rhythmic horizontal movement of the left eyeball (nystagmus). It is this combination of failure of one eye to look towards the nose, and nystagmus of the other eye that identifies INO. INO results in double vision (diplopia), since the eyes are not able to focus on the same target. When looking to the one side, if either eye is covered, the double vision will go away. Another abnormality that may be seen is double vision on upward gaze, since the eye on the side of the affected MLF will often be able to look “higher” than the other eye. Some INOs can be quite subtle, and difficult to identify, while others are obvious. In addition to double vision, individuals can experience visual confusion, transient visual sensations of objects swaying back and forth (oscillopsia), reading fatigue, and loss of depth perception (stereopsis). Intravenous steroid therapy can be administered for acute INO.
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