Read through the scenario below, think about what you would do and then check our expert advice to see if we agree.
A young adult patient recently attended my practice with a three-week history of intermittent horizontal diplopia, which worsened in lateral gaze but had no other significant symptoms. I observed an XOT, impaired adduction in the left eye during rightward gaze, and nystagmus in the abducting right eye. All other findings were normal. I referred them urgently to the local orthoptics department, but the referral triage service categorised the patient as a routine referral. What should I do? I am concerned they may have internuclear ophthalmoplegia (INO) and need to be seen urgently.
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These cases are based on member calls or emails made to our clinical advisers. We do not share any personal details of those seeking advice and have modified the cases to ensure confidentiality. This clinical file is intended to help members understand how the existing Guidance for Professional Practice (GfPP) can be applied in everyday practice, this clinical file is not intended as supplementary or additional annex to the GfPP.
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