Pulled-In-Two Syndrome in a Case of Wall Eyed Binocular Internuclear Ophthalmoplegia in Multiple Sclerosis

Binocular internuclear ophthalmoplegia (INO) is a well-documented manifestation of multiple sclerosis (MS) due to demyelination of the medial longitudinal fasciculus (MLF). Strabismus surgery is an infrequent treatment option that is approached rather cautiously in cases refractory to patching, and prism therapy, due to poor range of motion and the possibility of post-operative diplopia. Pulled-In-Two syndrome (PITS) is a rare serious complication of strabismus surgery characterized by the rupture of an extraocular muscle while under tension.