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Correct! This patient is displaying bursts of horizontal saccadic oscillations. You will be tempted to call this “ocular flutter,” a saccadic intrusion that reflects a serious disorder of the brainstem. But these eye movements are triggered by the patient, even if the patient is not always aware—or willing to admit—that these eye movements are under voluntary control. The patient cannot sustain these “back-to-back” fast oscillations for very long (they cause eye strain) and there are no accompanying neurologic manifestations such as ataxia or tremor, so common in true “ocular flutter.” Coincident convergence spasm and a psychogenic gait disturbance are other clues to a factitious disturbance.

Incorrect

Incorrect