2022 Feb 16;9(3):284-295.
 doi: 10.1002/mdc3.13413. eCollection 2022 Apr.

Eye Movement Disorders in Movement Disorders



  • 1National Institute of Neurological Disorders and Stroke, National Institutes of Health Bethesda Maryland USA.
  • 2Department of Neurology University of Utah Salt Lake City Utah USA.
  • 3Centre for Vestibular and Behavioural Neurosciences, Department of Clinical and Movement Neurosciences University College London, Institute of Neurology London UK.
  • 4New Zealand Brain Research Institute Christchurch New Zealand.
  • 5Department of Medicine University of Otago Christchurch New Zealand.
    • PMID: 35402641
    • PMCID: PMC8974874 (available on )


Oculomotor assessment is an essential element of the neurological clinical examination and is particularly important when evaluating patients with movements disorders. Most of the brain is involved in oculomotor control, and thus many neurological conditions present with oculomotor abnormalities. Each of the different classes of eye movements and their features can provide important information that can facilitate differential diagnosis. This educational review presents a clinical approach to eye movement abnormalities that are commonly seen in parkinsonism, ataxia, dystonia, myoclonus, tremor, and chorea. In parkinsonism, subtle signs such as prominent square wave jerks, impaired vertical optokinetic nystagmus, and/or the "round the houses" sign suggest early progressive supranuclear gaze palsy before vertical gaze is restricted. In ataxia, nystagmus is common, but other findings such as oculomotor apraxia, supranuclear gaze palsy, impaired fixation, or saccadic pursuit can contribute to diagnoses such as ataxia with oculomotor apraxia, Niemann-Pick type C, or ataxia telangiectasia. Opsoclonus myoclonus and oculopalatal myoclonus present with characteristic phenomenology and are usually easy to identify. The oculomotor exam is usually unremarkable in isolated dystonia, but oculogyric crisis is a medical emergency and should be recognized and treated in a timely manner. Gaze impersistence in a patient with chorea suggests Huntington's disease, but in a patient with dystonia or tremor, Wilson's disease is more likely. Finally, functional eye movements can reinforce the clinical impression of a functional movement disorder.

Keywords: eye; movement disorders; oculomotor; pursuit; saccades.