Skip to main content

Characterising eye movement dysfunction in myalgic encephalomyelitis/chronic fatigue syndrome



People who suffer from myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) often report that their eye movements are sluggish and that they have difficulties tracking moving objects. However, descriptions of these visual problems are based solely on patients’ self-reports of their subjective visual experiences, and there is a distinct lack of empirical evidence to objectively verify their claims. This paper presents the first experimental research to objectively examine eye movements in those suffering from ME/CFS.


Patients were assessed for ME/CFS symptoms and were compared to age, gender, and education matched controls for their ability to generate saccades and smooth pursuit eye movements.


Patients and controls exhibited similar error rates and saccade latencies (response times) on prosaccade and antisaccade tasks. Patients showed relatively intact ability to accurately fixate the target (prosaccades), but were impaired when required to focus accurately in a specific position opposite the target (antisaccades). Patients were most markedly impaired when required to direct their gaze as closely as possible to a smoothly moving target (smooth pursuit).


It is hypothesised that the effects of ME/CFS can be overcome briefly for completion of saccades, but that continuous pursuit activity (accurately tracking a moving object), even for a short time period, highlights dysfunctional eye movement behaviour in ME/CFS patients. Future smooth pursuit research may elucidate and improve diagnosis of ME/CFS.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. 1.

    For comprehensive reviews of ME/CFS, see [5, 6].

  2. 2.

    Degrees of freedom adjusted because Levene’s test for equality of variances was significant.

  3. 3.

    A similar pattern of results was found with the median gains averaged for each participant.


  1. 1.

    NICE Clinical Guideline 53, Developed by the National Collaborating Centre for Primary Care. (2007) Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): Diagnosis and management of CFS/ME in adults and children. Retrieved from [Accessed 10th April 2013]

  2. 2.

    Lorusso L, Mikhaylova SW, Capelli E, Ferrari D, Ngonga GK, Ricevuti G (2009) Immunological aspects of chronic fatigue syndrome. Autoimmun Rev 8:287–291

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    Chen R, Liang FX, Moriya J, Yamakawa J, Sumino H, Kanda T, Takahashi T (2008) Chronic fatigue syndrome and the central nervous system. J Int Med Res 36:867–874

    CAS  PubMed  Article  Google Scholar 

  4. 4.

    Hollingsworth KG, Jones DE, Taylor R, Blamire AM, Newton JL (2010) Impaired cardiovascular response to standing in chronic fatigue syndrome. Eur J Clin Invest 40:608–615

    PubMed  Article  Google Scholar 

  5. 5.

    Carruthers BM, Jain AK, De Meirleir KL, Peterson DL, Klimas NG, Lerner AM et al (2003) Myalgic encephalomyelitis ⁄ chronic fatigue syndrome: clinical working case definition, diagnostic and treatment protocols. J Chronic Fatigue Syndr 11:7–116

    Article  Google Scholar 

  6. 6.

    Carruthers BM, van de Sande MI, De Meirleir KL, Klimas NG, Broderick G, Mitchell T et al (2011) Myalgic encephalomyelitis: international consensus criteria. J Internal Med 270:327–338

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  7. 7.

    Christley Y, Duffy T, Martin CR (2012) A review of the definitional criteria for chronic fatigue syndrome. J Eval Clin Pract 18:25–31

    PubMed  Article  Google Scholar 

  8. 8.

    Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A (1994) The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann Intern Med 121:953–959

    CAS  PubMed  Article  Google Scholar 

  9. 9.

    Griffith JP, Zarrouf FA (2008) A systematic review of chronic fatigue syndrome: don’t assume it's depression. Prim Care Companion J Clin Psychiatry 10(2):120–128

    PubMed Central  PubMed  Article  Google Scholar 

  10. 10.

    Capuron L, Welberg L, Heim C, Wagner D, Solomon L, Papanicolaou DA et al (2006) Cognitive dysfunction relates to subjective report of mental fatigue in patients with chronic fatigue syndrome. Neuropsychopharm 31:1777–1784

    Article  Google Scholar 

  11. 11.

    Majer M, Welberg LAM, Capuron L, Miller AH, Pagnoni G, Reeves WC (2008) Neuropsychological performance in persons with chronic fatigue syndrome: results from a population study. Psychosom Med 70:829–836

    PubMed  Article  Google Scholar 

  12. 12.

    Michiels V, Cluydts R, Fischler B (1998) Attention and verbal learning in patients with chronic fatigue syndrome. J Int Neuropsychol Soc 4:456–466

    CAS  PubMed  Article  Google Scholar 

  13. 13.

    Cockshell SJ, Mathias JL (2010) Cognitive functioning in chronic fatigue syndrome: a meta-analysis. Psychol Med 40:1253–1267

    CAS  PubMed  Article  Google Scholar 

  14. 14.

    Cook DB, O’Connor PJ, Lange G, Steffener J (2007) Functional neuroimaging correlates of mental fatigue induced by cognition among chronic fatigue syndrome patients and controls. NeuroImage 36:108–122

    PubMed  Article  Google Scholar 

  15. 15.

    Flor-Henry P, Lind JC, Koles ZJ (2010) EEG source analysis of chronic fatigue syndrome. Psychiat Res 181:155–164

    Article  Google Scholar 

  16. 16.

    Lange G, Steffener J, Cook DB, Bly BM, Christodoulou C, Liu WC et al (2005) Objective evidence of cognitive complaints in Chronic Fatigue Syndrome: A BOLD fMRI study of verbal working memory. Neuroimage 26:513–524

    CAS  PubMed  Article  Google Scholar 

  17. 17.

    Leslie S (1997) Chronic fatigue syndrome: optometric clinical presentation and management. J Behav Optom 8:155–161

    Google Scholar 

  18. 18.

    Potaznick W, Kozol N (1992) Ocular manifestations of chronic fatigue and immune dysfunction syndrome. Optom Vis Sci 69:811–814

    CAS  PubMed  Article  Google Scholar 

  19. 19.

    Vedelago LJ (1997) Visual dysfunction in chronic fatigue syndrome. J Behav Optom 8:149–154

    Google Scholar 

  20. 20.

    Sereno AB, Holzman PS (1995) Antisaccades and smooth pursuit eye movements in schizophrenia. Biol Psychiatry 37:394–401

    CAS  PubMed  Article  Google Scholar 

  21. 21.

    Jason LA, Evans M, Porter N, Brown M, Brown A, Hunnell J et al (2010) The development of a revised Canadian myalgic encephalomyelitis chronic fatigue syndrome case definition. Am J Biochem Biotechnol 6:120–135

    Article  Google Scholar 

  22. 22.

    Bach M (1996) The “Freiburg Visual Acuity Test” — automatic measurement of visual acuity. Optom Vis Sci 73:49–53

    CAS  PubMed  Article  Google Scholar 

  23. 23.

    Wechsler D (1981) Manual for the Wechsler adult intelligence scale—revised. Psychological Corporation, New York

    Google Scholar 

  24. 24.

    Austin MP, Mitchell P, Wilhelm K, Parker G, Hickie I, Brodaty H et al (1999) Cognitive function in depression: a distinct pattern of frontal impairment in melancholia? Psychol Med 29:73–85

    CAS  PubMed  Article  Google Scholar 

  25. 25.

    Hoyer WJ, Stawski RS, Wasylyshyn C, Verhaeghen P (2004) Adult age and digit symbol substitution performance: a meta-analysis. Psychol Aging 19:211–214

    PubMed  Article  Google Scholar 

  26. 26.

    Holzman PS, O’Brian C, Waternaux C (1991) Effects of lithium treatment on eye movements. Biol Psychiatry 29:1001–1015

    CAS  PubMed  Article  Google Scholar 

  27. 27.

    Smyrnis N (2008) Metric issues in the study of eye movements in psychiatry. Brain Cogn 68:341–358

    PubMed  Article  Google Scholar 

  28. 28.

    O’Driscoll GA, Callahan BL (2008) Smooth pursuit in schizophrenia: a meta-analytic review of research since 1993. Brain Cogn 68:359–370

    PubMed  Article  Google Scholar 

  29. 29.

    Ross RG, Olincy A, Zerbe G, Radant A (2003) Which duration of postsaccadic slowing identifies anticipatory saccades during smooth pursuit eye movements? Psychophysiology 38:325–333

    CAS  Article  Google Scholar 

  30. 30.

    Bäckman L, Small BJ, Wahlin A, Larsson M (2000) Cognitive functioning in very old age. In: Salthouse TA, Craik FIM (eds) The handbook of aging and cognition, 2nd edn. Lawrence Erlbaum Associates, Inc., Mahwah, pp 499–558

    Google Scholar 

Download references


This research was funded by ME Research UK and the Irish ME Trust. We are extremely grateful to all our participants, especially those suffering from ME/CFS, for taking part in the study. We thank Professor Leonard Jason, DePaul University, Chicago for kindly providing us with the DePaul Symptom Questionnaire (DSQ).

Author information



Corresponding author

Correspondence to Stephen P. Badham.

Additional information

The authors have no financial relationship with the body that funded this research. The authors have full control of all primary data, and agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review their data upon request.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Badham, S.P., Hutchinson, C.V. Characterising eye movement dysfunction in myalgic encephalomyelitis/chronic fatigue syndrome. Graefes Arch Clin Exp Ophthalmol 251, 2769–2776 (2013).

Download citation


  • Myalgic encephalomyelitis (ME)
  • Chronic fatigue syndrome (CFS)
  • Eye movements
  • Prosaccades
  • Antisaccades
  • Smooth pursuit