Paroxysmal ocular downward deviation in 13 children with spastic quadriplegia, mental retardation and cortical visual impairment is reported from the Department of Pediatric Neurology, Seirei-Mikatabara General Hospital, Hamamatsu, Shizuoka, Japan. The ocular abnormality was observed in infancy, predominantly in pre-term infants and it resolves spontaneously in many by 2 years of age. The movement differed from the setting sun sign or tonic downward deviation and was not accompanied by retraction of the eyelids. No patient had hydrocephalus or kernicterus. [1]

COMMENT. The CT and MRI in these patients showed periventricular leukomalacia or multicystic encephalomalacia with involvement of optic radiations. Paroxysmal ocular downward deviation is proposed as a new sign of brain damage with central visual impairment, particularly in preterm infants.

Transient chronic upgaze differs from that of the transient variety of tonic downgaze deviation of the eyes in newborns, being more persistent and exacerbated by fatigue or illness. [2]