Complete Bilateral horizontal gaze paralysis is a rare syndrome, etiology being infarction, inflammation/demyelination, hemorrhage (), and metastasis. 

1. A 39 year old female presented with improving diplopia of 15 days duration. She was found to have complete bilateral horizontal gaze palsy unable to be overcome by Vestibulo-ocular reflex. Convergence and vertical eye movements were normal. MRI brain showed few periventricular lesions and hyperintensity in paramedian floor of 4^th ventricle.

2. A 36 year old male presented with diplopia of 1 day duration and was found to have bilateral internuclear ophthalmoplegia by an Ophthalmologist.The MRI brain showed 3 small periventricular white matter lesions without a brainstem pathology. Within 5 days, he developed partial right and complete left horizontal gaze palsy and left LMN facial paralysis when seen in my clinic. Cerebral MRI acoustic protocol showed lesion in pontine tegmentum.

1.       Bilateral damage to medial longitudinal fasciculus followed by subsequent lateral extension to abducens nerves, and left facial nerve fasciculus in second patient might explain the clinical findings. 

2.      MRI brain with acoustic protocol might be more beneficial in localizing brainstem pathology in early stages.

3.       Knowledge about this syndrome among neurologists and ophthalmologists would minimize unnecessary investigations, delay in diagnosis and treatment.