One and a half syndrome
![Schematic representation of most common extra-ocular movement abnormality in one and a half syndrome.](/Images/godic/202501/31/One_and_a_half0903.jpg")
![Scheme showing anatomical location of lesions in one and a half syndrome.](/Images/godic/202501/31/One_and_a_half_syndrome.svg0903.png")
The one and a half syndrome is a rare weakness in eye movement affecting both eyes, in which one cannot move laterally at all, and the other can move in only one lateral direction (inward or outward). More formally, it is characterized by "a conjugate horizontal gaze palsy in one direction and an internuclear ophthalmoplegia in the other". The most common manifestation of this unusual syndrome is limitation of horizontal eye movement to abduction (moving away from the midline) of one eye (e.g. right eye in the diagram on the right) with no horizontal movement of the other eye (e.g. left eye in the diagram on the right). Nystagmus is also present when the eye on the opposite side of the lesion is abducted. Convergence is classically spared as cranial nerve III (oculomotor nerve) and its nucleus is spared bilaterally.