Familial, congenital paralysis of horizontal gaze

Eye movements were studied in a sister and brother with familial, congenital paralysis of horizontal gaze. Horizontal and vertical eye movements were recorded with DC electro-oculography and analyzed with a laboratory computer. All horizontal, conjugate eye movements were absent (saccades, pursuit, optokinetic nystagmus, vestibulo-ocular response, and visual-vestibular responses). Voluntary vergence eye movements were preserved and were used to track visual targets. An involuntary, horizontal, pendular nystagmus was found to represent disconjugate, smooth, vergence eye movements. Vertical saccades and vestibulo-ocular responses were normal. However, vertical pursuit, optokinetic nystagmus, and suppression of the vestibulo-ocular response by fixation were impaired. A developmental anomaly affecting motor neurons and interneurons in the abducens nuclei is suggested to be the cause of the absence of conjugate, horizontal eye movements.