Omnidirectional Slow Saccades
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Slow saccades in all directions caused by damage to the brainstem saccadic generators or the extraocular muscles
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Common causes: spinocerebellar ataxia, progressive supranuclear palsy, genetic extraocular myopathy, multiple sclerosis
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Uncommon cause: paraneoplastic disorders
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Core clinical feature
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Slow saccades in all directions (“eyes in molasses”)
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Possible accompanying neuro-ophthalmic features
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Saccadic intrusions
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Nystagmus
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Skew deviation
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Esotropia
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Convergence insufficiency
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Bilateral ptosis in genetic extraocular myopathies (See
Genetic Extraocular Myopathies
)
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Possible accompanying neurologic features
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Cognitive decline
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Parkinsonism
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Spasticity
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Ataxia
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Dysautonomia
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Imaging features
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Brainstem or cerebellar atrophy
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Thin (atrophic) extraocular muscles and levator in genetic extraocular myopathies
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Sedative medication
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Poor effort
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Metabolic encephalopathy
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Graves disease
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Fisher variant of Guillain-Barré syndrome
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Complex ocular motor cranial nerve palsies
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Phenytoin toxicity
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Whipple disease
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Wernicke disease
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Order appropriate tests based on clinical abnormalities
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Treat with thiamine for a presumptive diagnosis of Wernicke disease if there has been bariatric surgery, anorexia, an unusual diet, or alcoholism
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Refer as appropriate for genetic testing of inherited ataxias, muscle biopsy for mitochondrial myopathy, PCR for Whipple antigen
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Depends on the underlying condition
