BACKGROUND: This report documents a case of a 28 year old female who presented with walled-eyed binocular internuclear ophthalmoplegia (WEBINO), Terson's Syndrome, vestibular nystagmus and shallow retinal detachments.
CASE REPORT(S). The patient presented with reduced visual acuity, a mild relative afferent pupillary defect in the right eye and a left homonymous hemianopsia. Motilities showed vestibular nystagmus with head nodding. In addition, ipsilateral adduction was absent, there was contralateral nystagmus in abduction, no convergence, and a large alternating exotropia in primary gaze. This is known as WEBINO and is localized to the midbrain. Fundus exam revealed bilateral temporal pallor of the optic nerve greater in the right eye, shallow serous detachments in both eyes and a vitreal veil in the right eye. The vitreal veil was due to a subarachnoid hemorrhage in the brain which followed the meninges into the eye bleeding into the vitreous. This is known as Terson's Syndrome. This presentation was secondary to a cerebral hemorrhage from eclampsia.
CONCLUSIONS. Cerebral hemorrhages have many ocular manifestations other than commonly seen homonymous visual field defects and papilledema. WEBINO, Terson's Syndrome and vestibular nystagmus are among the many complications of a cerebral vascular accident due to eclampsia.