Abnormal supranuclear eye movements in the child: A practical guide to examination and interpretation

Abnormal eye movements in the infant or young child can be congenital or ac quired. They may be a result of abnormal early visual development or a sign of underlying neurologic or neuromuscular disease. It is important to be a ble to detect these abnormalities and to distinguish them from normal but i mmature eve movements. The spectrum of disease in children differs from tha t in adults. Serious, potentially fatal but treatable disorders call be acq uired in infancy, and abnormal eye movements in a sometimes apparently well child should never be labeled as congenital or benign without careful inve stigation. Eye movement analysis can indicate the presence of an underlying condition and help the clinician to classify different neurologic diseases . It is important to carefully examine the ocular motor system in any child ren at risk of neurologic disease. This review provides a practical guide t o the examination and interpretation of eye movements in the child and incl udes recent literature on eye movement disorders of childhood. We describe supranuclear abnormalities of the ocular motor system in the order in which we would normally examine it: saccades, pursuit, convergence, vestibule-oc ular reflex, and optokinetic nystagmus. Nystagmus, internuclear ophthalmopl egia, cranial nerve abnormalities, and "miswiring" phenomena (such as Duane 's syndrome and synergistic divergence) are not discussed, (Surv Ophthalmol 44:479-506, 2000. (C) 2000 by Elsevier Science Inc. All rights reserved.).