By Jacqueline M.S. Winterkorn, MD, PhD
    Focal Points: Ophthalmic Features of Neurodegenerative Diseases

    This 59-year-old woman has a Parkinson plus syndrome: progressive supranuclear palsy (PSP).  She exhibits axial rigidity and her eye movements are abnormal. Fixation is interrupted by frequent square-wave jerks.  Her pursuit is jerky, more so vertically than horizontally.  She has slow, hypometric horizontal saccades and absent vertical saccades. Her supranuclear gaze palsy is worse vertically than horizontally.  When she tries to look down, she frequently “dolls” her eyes up.  Absence of downgaze is also typical of PSP.