Neuro-ophthalmology of movement disorders

Current Opinion in Ophthalmology

Clark, David; Eggenberger, Eric

23(6): 491-496 November 2012

Purpose of review: Movement disorders commonly present with ocular features. The purpose of this review is to outline neuro-ophthalmologic findings that can help in diagnosis, treatment and determining prognosis in patients with movement disorders.

Recent findings: Common movement disorders with ophthalmic symptoms include extrapyramidal disorders such as Parkinson disease-associated dry eye, decreased blink rate, and vergence dysfunction, and progressive supranuclear palsy-related lid retraction, frequent square-wave jerks and supranuclear gaze palsy. Multisystem atrophy can present with gaze-evoked horizontal or positional downbeat nystagmus and impaired vestibulo-ocular reflex suppression. Genetic disorders such as Huntington disease produce increased saccadic latencies and impaired suppression of saccades to presented stimulus, whereas Wilson disease is associated with saccadic pursuits, increased antisaccade latencies and decreased pursuit gain. Whipple's disease can present with supranuclear gaze palsy and characteristic oculomasticatory myorrhythmia.

Summary: Movement disorders commonly present with ocular features. Knowledge of these ocular symptoms can assist the ophthalmologist in diagnosis and treatment of movement disorders.

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