Table 3 A summary of normal clinical findings when examining supranuclear eye movements in children [1, 33, 34]
Age | Eye movement | |||||
|---|---|---|---|---|---|---|
VOR | OKR (or OKN) | Saccades | Gaze holding | Vergence | Smooth pursuit | |
Full-term infant | Both slow and quick phases are present in most. ‘Locking up’ (eyes fixed in either left or right gaze) due to lack of the quick phase can be seen in some normal infants until 45 wks gestation | Binocular OKR is present. Monocular OKR is present to temporal-to-nasal but not nasal-to-temporal stimuli. Approximately 1–2 fast phases per second | Saccades are hypometric (fall short of target). Small secondary saccades can be seen especially after large saccades. Appear to have normal speed | Very eccentric gaze holding is rarely seen in healthy neonates. To moderate eccentricities, it appears normal (no back-drift) | Most are slightly divergent and no convergence movements are seen | Not usually present. Coarse, often jerky (saccadic) movements to large, slow targets develop in first few weeks |
3 months | Clinically normal | Naso-temporal asymmetry (described above) disappears to moderate stimulus speed | Saccades become less hypometric and secondary saccades are smaller but may be seen | As above | Divergence has reduced or gone and coarse convergence movements can be seen | Usually seen to large slow moving targets. Become saccadic if target is moved more quickly |
6 months | Clinically normal | As above | As above | Clinically normal | Divergence has usually gone and convergence movements are more established as fusion develops | Start to become saccadic only to fast target speeds |
1 y | Clinically normal | Clinically normal with fast phase frequency increasing to 2–4 per second | Clinically normal (still hypometric as in adults but secondary saccades rarely seen) | Clinically normal | Clinically normal | As above |
5 y | Clinically normal | Clinically normal | Clinically normal | Clinically normal | Clinically normal | Clinically normal |
