Ophthalmic findings in the Parinaud syndrome

Vertical gaze abnormalities, especially upgaze

Downward gaze preference or tonic downward deviation of the eyes ("setting-sun sign")

Primary position upbeat or downbeat nystagmus

Impaired convergence and divergence

Excessive convergence tone

Convergence-retraction nystagmus

Skew deviation, often with the higher eye on the side of the lesion

Alternating adduction hypertropia or alternating adduction hypotropia

Bilateral upper eyelid retraction (Collier "tucked-lid" sign)

Bilateral ptosis

Pupillary abnormalities (large with light-near dissociation)

Modified with permission from: Lee AG, Brazis PW. Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach, Thieme, New York 1998.

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