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Oculomotor synkinesis

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Oculomotor synkinesis is a regenerative phenomenon of the third cranial nerve that occurs as a result of both misdirection of sprouting axons and of ephaptic transmission - cross-talk between axons without covering sheaths. Features are variable and may include:

  • lid elevation on attempted downgaze - levator palpebrae superioris fires as inferior rectus fires
  • adduction on attempted upgaze - medial rectus fires as superior rectus fires
  • retraction on attempted upgaze - recti act as retractors and fire together
  • pseudo-Argyll Robertson pupil - pupil constricts when eye is adducted - pupillary innervation from medial rectus
  • pseudo-Von Graefe's sign - no lid lag on downgaze but lid retraction due to innervation of levator palpebrae superioris from fibres distributed to inferior rectus
  • monocular vertical optokinetic nystagmus response

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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