{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:21:47Z","timestamp":1787772107388,"version":"build-2784847793"},"reference-count":11,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract:<\/jats:title>\n                  <jats:p>Multiple sclerosis (MS) is the most common demyelinating disease affecting the central nervous system. It has a wide range of manifestations and commonly affects the visual system. Many patients with MS report decreased vision, diplopia, nystagmus, and abnormal ocular motility. Nevertheless, bilateral horizontal gaze palsies are exceptionally rarely seen. We present the case of a 24-year-old female who came to our pediatric ophthalmology clinic complaining of bilateral horizontal gaze palsy, photophobia, and eye pain for 2 days. Although the patient had a family history of MS, there was no similar or previous complaint, with an unremarkable past medical and surgical history. During the examination, she was found to have a complete bilateral absence of horizontal saccade and pursuit, with slight limitations in vertical ones. There was no nystagmus or skew deviation, and the rest of the cranial nerves (CNs) were intact. Her ocular vital signs were normal, and her corrected visual acuity was 20\/20 with full-color vision. The rest of the physical and neurological examinations were unremarkable. After referral to neurology, the magnetic resonance imaging showed multiple hyperintense lesions in deep white matter, pons, and midbrain. The correlation of imaging findings with clinical presentation confirmed the diagnosis of a clinically isolated syndrome. Extra-ocular motility (EOM) significantly improved after pulse steroid therapy and five sessions of plasma exchange, but the patient developed 35 prism diopter of acquired concomitant esotropia. She underwent a right medial rectus botulinum toxin injection which dramatically improved her condition, and became orthotropic during the last 2 months of follow-up after the injection.<\/jats:p>","DOI":"10.4103\/sjopt.sjopt_106_23","type":"journal-article","created":{"date-parts":[[2024,3,29]],"date-time":"2024-03-29T13:00:07Z","timestamp":1711717207000},"page":"59-63","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Bilateral horizontal gaze palsy as an initial presentation of a clinically isolated syndrome: A case report"],"prefix":"10.4103","volume":"38","author":[{"given":"Ghadah","family":"Alnosair","sequence":"first","affiliation":[{"name":"Department of Pediatric Ophthalmology, Dammam Medical Complex, Dammam, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalid A.","family":"Alanazi","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, King Fahad University Hospital, Al Khobar, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatima I.","family":"Alhumaid","sequence":"additional","affiliation":[{"name":"College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bayan S.","family":"Alshuhayb","sequence":"additional","affiliation":[{"name":"College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,10,12]]},"reference":[{"key":"R1-20240830","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1097\/01.icu.0000179804.49842.e2","article-title":"Ocular manifestations of multiple sclerosis","volume":"16","author":"Chen","year":"2005","journal-title":"Curr Opin Ophthalmol"},{"key":"R2-20240830","doi-asserted-by":"crossref","first-page":"10857","DOI":"10.1038\/s41598-018-29206-y","article-title":"Natural course of clinically isolated syndrome:A longitudinal Analysis using a Markov model","volume":"8","author":"Hou","year":"2018","journal-title":"Sci Rep"},{"key":"R3-20240830","first-page":"534","article-title":"Multiple sclerosis:Review of eye movement disorders and update of disease-modifying therapies","volume":"26","author":"Amezcua","year":"2015","journal-title":"Curr Opin Ophthalmol"},{"key":"R4-20240830","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1111\/ncn3.12395","article-title":"A case of pure bilateral horizontal gaze palsy due to multiple sclerosis","volume":"8","author":"Hatake","year":"2020","journal-title":"Neurol Clin Neurosci"},{"key":"R5-20240830","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1186\/s12883-019-1494-0","article-title":"Complete horizontal gaze palsy due to bilateral paramedian pontine reticular formation involvement as a presentation of multiple sclerosis:A case report","volume":"19","author":"Akhavan Sigari","year":"2019","journal-title":"BMC Neurol"},{"key":"R6-20240830","first-page":"1","article-title":"Complete bilateral horizontal gaze palsy as initial manifestation of multiple sclerosis:A case report","volume":"8","author":"Gamea","year":"2021","journal-title":"J Mult Scler"},{"key":"R7-20240830","doi-asserted-by":"crossref","first-page":"84","DOI":"10.26815\/acn.2019.00115","article-title":"Isolated unilateral sixth nerve palsy as the first manifestation of multiple sclerosis","volume":"27","author":"Park","year":"2019","journal-title":"Ann Child Neurol"},{"key":"R8-20240830","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1136\/jnnp.55.10.863","article-title":"The ocular manifestations of multiple sclerosis. 2. Abnormalities of eye movements","volume":"55","author":"Barnes","year":"1992","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"R9-20240830","first-page":"637","article-title":"Frequency of ocular manifestations in multiple sclerosis patients admitted in tertiary care hospital in Saudi Arabia","volume":"26","author":"Alharbi","year":"2022","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"R10-20240830","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1136\/jnnp.70.2.252","article-title":"Complete bilateral horizontal gaze paralysis disclosing multiple sclerosis","volume":"70","author":"Milea","year":"2001","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"R11-20240830","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1007\/BF02173302","article-title":"Botulinum toxin treatment of acute sixth and third nerve palsy","volume":"226","author":"Metz","year":"1988","journal-title":"Graefes Arch Clin Exp Ophthalmol"}],"container-title":["Saudi Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/sjopt.sjopt_106_23","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T18:29:41Z","timestamp":1787768981000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/sjopt.sjopt_106_23"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,12]]},"references-count":11,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.4103\/sjopt.sjopt_106_23","relation":{},"ISSN":["1319-4534","2542-6680"],"issn-type":[{"value":"1319-4534","type":"print"},{"value":"2542-6680","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,12]]},"assertion":[{"value":"2023-05-13","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-08-17","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}