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Cerebellar Control of Eye Movements

Beh, Shin C. MD; Frohman, Teresa C. PA-C; Frohman, Elliot M. MD, PhD

Section Editor(s): Biousse, Valérie MD; Galetta, Steven MD

Journal of Neuro-Ophthalmology: March 2017 - Volume 37 - Issue 1 - p 87–98
doi: 10.1097/WNO.0000000000000456
State-of-the-Art Review

Background: The cerebellum plays a central role in the online, real-time control, and long-term modulation of eye movements.

Evidence acquisition: We reviewed the latest (fifth) edition of Leigh and Zee's textbook, The Neurology of Eye Movements, and literature in PUBMED using the following terms: cerebellum, flocculus, paraflocculus, vermis, oculomotor vermis, dorsal vermis, caudal fastigial nucleus, fastigial oculomotor region, uvula, nodulus, ansiform lobule, eye movements, saccades, ipsipulsion, contrapulsion, smooth pursuit, vergence, convergence, divergence, gaze-holding, down beat nystagmus, vestibulo-ocular reflex (VOR), angular VOR, translational VOR, skew deviation, velocity storage.

Results: The cerebellum is vital in optimizing the performance of all classes of gaze-shifting and gaze-stabilizing reflexes. The flocculus-paraflocculus are crucial to VOR gain and direction, pulse-step matching for saccades, pursuit gain, and gaze-holding. The ocular motor vermis and caudal fastigial nuclei are essential in saccadic adaptation and accuracy, and pursuit gain. The nodulus and ventral uvula are involved in processing otolothic signals and VOR responses, including velocity storage.

Conclusions: The cerebellum guarantees the precision of ocular movements to optimize visual performance and occupies a central role in all classes of eye movements both in real-time control and in long-term calibration and learning (i.e., adaptation).

Departments of Neurology (SCB, TCF, EMF), and Ophthalmology (EMF), University of Texas Southwestern Medical Center, Dallas, Texas.

Address correspondence to Shin C. Beh, MD, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235; E-mail:

T. C. Frohman has received speaker and consultant fees from Genzyme, Novartis and Acorda. E. M. Frohman has received speaking and consulting fees from, TEVA Neuroscience, Genzyme, Acorda, and Novartis. The remaining author reports no conflicts of interest.

© 2017 by North American Neuro-Ophthalmology Society