The involuntary movement of the eyes rolling upward, known clinically as superior gaze deviation, can be alarming to witness. This phenomenon has a wide range of underlying causes, spanning from normal physiological responses to serious medical events. Understanding the context in which the eye movement occurs is important for determining whether the situation is benign or requires immediate medical attention. Eye rolling signals a temporary disruption or imbalance in the complex neurological systems that control ocular muscles.
Understanding Non-Concerning Eye Movement
The eyes commonly roll back during the transition into or out of sleep. This movement is part of Bell’s phenomenon, a natural protective reflex that causes the eyeballs to turn upward and slightly outward when the eyelids close or during sleep onset. In the initial stages of non-rapid eye movement (NREM) sleep, the eyes may slowly roll back before settling.
Rapid eye movements (REM) characterize the deepest stage of sleep, involving quick, random movements, but not a sustained upward roll. The eyes may also briefly deviate upward during deep concentration or relaxation. Syncope, the medical term for fainting, is another non-concerning cause. During a vasovagal syncopal episode, temporary loss of blood flow to the brain can cause the eyes to roll back just before or during the brief loss of consciousness.
Neurological Conditions That Cause Eye Rolling
Involuntary upward eye deviation is a recognizable sign in several serious neurological conditions, including seizure activity. During a generalized tonic-clonic seizure, uncontrolled electrical activity in the brain disrupts normal muscle control, leading to the eyes rolling backward or moving rhythmically. Focal seizures, which affect only one part of the brain, can also result in the eyes deviating to one side or upward, often accompanied by loss of consciousness or muscle stiffening.
A distinct neurological movement disorder presenting as eye rolling is called oculogyric crisis (OGC). OGC is characterized by a sustained, involuntary upward deviation of the eyes. These episodes are a form of acute dystonia, involving involuntary muscle contractions, and can last from seconds to several hours. The underlying issue often relates to dysfunction in the basal ganglia, particularly an imbalance in the dopaminergic and cholinergic neurotransmitter systems. OGC can also present with other signs, such as neck flexion, widely opened mouth, or painful jaw spasms.
Drug-Induced Eye Movements
Certain substances and medications can induce oculogyric crisis (OGC) as a side effect, making this a distinct cause separate from inherent neurological disease. This drug-induced reaction is a form of acute dystonia, where the medication temporarily disrupts the brain’s motor control pathways. High-potency first-generation antipsychotics are historically the most common cause, but atypical antipsychotics, anti-nausea drugs, and some antidepressants have also been implicated.
These medications work by blocking dopamine receptors, leading to the neurotransmitter imbalance in the basal ganglia that triggers the involuntary eye movement. If eye rolling begins shortly after starting a new psychiatric medication or increasing a dose, it suggests a drug-induced reaction. Treatment involves discontinuing the offending drug and administering anticholinergic medications or antihistamines to quickly relieve the muscle spasm.
Identifying Signs for Emergency Care
The context of the eye rolling dictates the need for emergency care. If the eye movement is brief and the person remains fully responsive, such as during relaxation or while falling asleep, it is generally not a medical emergency. However, eye rolling that occurs suddenly and is accompanied by other symptoms warrants immediate attention.
Specific red flags necessitate calling emergency services. These include any episode where the eye rolling is accompanied by:
- Loss of consciousness, unresponsiveness, or confusion following the event.
- Rhythmic jerking movements of the limbs, body stiffening, or loss of bladder control (strong indicators of a seizure).
- Following a recent head injury.
- Involuntary movement that persists for more than a few minutes.
Immediate medical evaluation is necessary in these cases to rule out severe underlying conditions like a stroke or brain trauma.