infranuclear
Infranuclear describes an eye movement disorder caused by damage to the ocular motor nuclei or to the third, fourth, and sixth cranial nerves, which carry eye movement commands from the brainstem to the individual extraocular muscles. An infranuclear ocular motor palsy can arise anywhere from the nucleus to the extraocular muscle.1 Some texts draw the line more narrowly, calling the ocular motor nuclei nuclear structures and reserving infranuclear for the exiting fascicles and nerves.2
Strabismus texts sort neurogenic paralyses of the extraocular muscles by the seat of the lesion into supranuclear, nuclear, and infranuclear types. Disease of the muscle itself is classed separately as a myogenic paralysis.3
The vestibulo-ocular reflex helps tell a supranuclear gaze palsy from an infranuclear one. The reflex is maintained in a supranuclear lesion but lost in an infranuclear lesion.4 In the doll's head test, the examiner rotates the head while the patient fixates, and a normal reflex moves the eyes equal and opposite to the head.4
Sources (9)
- Yanoff and Duker, Ophthalmology (2023), ch. 9.15
- Liu, Volpe and Galetta, Neuro-Ophthalmology: Diagnosis and Management, ch. 16
- von Noorden and Campos, Binocular Vision and Ocular Motility, ch. 8
- Pickwell's Binocular Vision Anomalies, ch. 17
- Caloroso, E.E., Rouse, M.W. (1993). Clinical Management of Strabismus. Butterworth-Heinemann.
- Rutstein, R., Daum, K. (1997). Anomalies of Binocular Vision: Diagnosis & Management, Mosby.
- Scheiman, M., Wick, B. (2014). Clinical Management of Binocular Vision: Heterophoric, Accommodative, and Eye Movement Disorders. 4th ed., Lippincott Williams & Wilkins.
- Rowe, F.J. (2012). Clinical Orthoptics. 3rd ed., Wiley-Blackwell.
- Noorden, G.K.V., Campos, E.C. (2002). Binocular Vision and Ocular Motility: Theory and Management of Strabismus. 6th ed., Mosby.
Reviewed October 2026