A 64-year-old woman presented with complaints about facial spasms, difficulty in opening her mouth and intermittent short episodes of horizontal diplopia. The diagnosis of a purely cephalic tetanus was made. While her eye movements appeared normal on clinical examination, infrared reflection oculography revealed a saccadic abnormality which could explain her diplopia. In view of today's pathophysiological concepts on tetanus an attempt is made to explain the eye movement disorder by disturbed inhibitory mechanisms in the brainstem.
