Clinical Pearls - Eye Signs

I just came across some eye signs and the conditions in which they were present and its really fascinating to know their significance.

1. Bilateral Ptosis in a middle aged lady with a recent Right MCA infarct and old Left MCA infarct.

It occurs frequently in patients with hemispheric strokes, especially in association with right hemispheric lesions. Complete bilateral ptosis is usually caused by large infarctions and may be a premonitory sign of an impending herniation.Isolated b/l ptosis has been previously reported in association with midbrain lesions due to subacute encephalitis and midbrain hemorrhage.
Complete ophthalmoplegia, the combination of bilateral ptosis with loss of all extraocular movements, is rarely a consequence of ischemic stroke can be manifestation of bilateral paramedian midbrain-thalamic infarction.

2. Upward Gaze Deviation in a 26 year old man with hypoxic ischaemic brain damage secondary to cardiomyopathy and cardiac arrest.
This deviation is seen in hypoxic brain damage as their is loss of cerebellar Purkinje cells that normally balance vestibular and gaze - holding mechanisms.
In contrast tonic downward gaze deviation with small unreactive pupls is seen in camatose patients due to bilateral thalamic infarction or haemorrhage.