Objective: To report an unusual video case of paroxysmal conjugate saccadic ocular oscillations and discuss the challenges in the diagnostic process differentiating ocular movement disorders.
Background: Differentiating between ocular movement disorders may be challenging because of overlapping phenomenological features such as high-frequency, conjugate horizontal eye movements. In such cases, a comprehensive clinical and instrumental evaluation is essential.[1,2,3]
Method: Clinical examination, brain MRI, routine blood tests, neuronal autoantibodies, cerebrospinal fluid (CSF) analysis, total-body FDG-PET, electro-oculography (EOG) and video-oculography (VOG).
Results: A 44-year-old woman presented to the emergency department with a 7-day history of dizziness. She denied nausea, vomiting, or diplopia. Family and personal medical history were negative for neurological diseases or psychiatric disorders. Drugs intoxications were excluded. Neurological examination revealed brief, gaze-evoked, paroxysmal bursts of high-frequency, low-amplitude conjugate horizontal ocular oscillations with a simultaneous jerky low-amplitude head tremor. The remainder of the examination was unremarkable. The patient was not aware of the abnormal eye movements and was unable to voluntarily evoke nor suppress them. EOG [Figure1] and VOG [Figure2] showed brief flutter-like back-to-back high-frequency conjugate horizontal oscillations during fixation and smooth pursuit movement, also occurring with closed eyelids. No intersaccadic intervals were detected. Distraction maneuvers did not suppress the bursts. Blood and CSF analysis, including erum and CSF neuronal autoantibody panel, brain MRI, and total-body FDG-PET were unremarkable. At 3 months follow-up the ocular oscillations were barely detectable and the head tremor had resolved spontaneously. A possible functional origin of the disorder was therefore considered.
Conclusion: We report a video case of flutter-like ocular oscillations in a patient without a detectable organic cause. The brief nature of the episodes, the absence of other neurological signs and the negative diagnostic work-up excluded a typical organic ocular flutter syndrome. This case highlights the diagnostic overlap between ocular flutter and functional ocular nystagmus and underscores the importance of careful neurologic assessment in unusual eye movement disorders.
Electro-oculography (EOG) recording
Video-oculography: smooth pursuit(a), fixation(b)
References: [1] Kaski, D., Bronstein, A. M., Edwards, M. J., & Stone, J. (2015). Cranial functional (psychogenic) movement disorders. The Lancet. Neurology, 14(12), 1196–1205. https://doi.org/10.1016/S1474-4422(15)00226-4
[2] Rosenberg M. L. (2021). Involuntary “Voluntary” Nystagmus. Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society, 41(4), e688–e691. https://doi.org/10.1097/WNO.0000000000001196
[3] Vavougios, G. D., Pelidou, S. H., Mavromatis, T., Mandras, D., & Ntoskas, T. (2020). Spontaneous, isolated, and gaze-evoked ocular flutter: A rare case report. Clinical case reports, 8(6), 955–957. https://doi.org/10.1002/ccr3.2719.
To cite this abstract in AMA style:
A. Mechelli, A. Gozzi, P. Antenucci, G. Linzalone, A. Ciorba, D. Gragnaniello, J. Capone, M. Sensi. “Shaky Eyes”: an Unusual Case of Ocular Movement Disorder [abstract]. Mov Disord. 2026; 41 (suppl 1). https://www.mdsabstracts.org/abstract/shaky-eyes-an-unusual-case-of-ocular-movement-disorder/. Accessed October 1, 2026.« Back to 2026 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/shaky-eyes-an-unusual-case-of-ocular-movement-disorder/