February 2025: Case on managing sudden onset diplopia

Read through the scenario below, think about what you would do and then check our expert advice to see if we agree.

Case on managing sudden onset diplopia

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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