Smooth pursuit eye movements (SPEM) are the conjugate movements used to track the smooth trajectory of small dots. Jerky or ‘saccadic‘ocular pursuit has been reported in patients with cirrhosis, but no formal assessment of SPEM has ever been undertaken. The aim of this study was to evaluate SPEM in patients with ci rrhosis and varying degrees of hepatic encephalopathy. The patient population co mprised 56 individuals (31 men, 25 women) of mean age 51.1 (range, 25-70) years , with biopsy-proven cirrhosis, classified, using clinical, electroencephalogra phic, and psychometric variables, as either neuropsychiatrically unimpaired or a s having minimal or overt hepatic encephalopathy; patients were further categori zed in relation to their treatment status. The reference population comprised 28 healthy volunteers (12 men, 16 women) of mean age 47.3 (range, 26-65) years. S PEM was assessed using an electro-oculographic technique. Visual inspection of the SPEM recordings showed clear disruption of smooth pursuit in the patients wi th minimal hepatic encephalopathy, and more pronounced disruption, if not comple te loss, of smooth pursuit in patients with overt hepatic encephalopathy. The di fferences observed in quantifiable SPE Mindices between the healthy volunteers/u nimpaired patients and those with overt hepatic encephalopathy were significant (P < .05). In con clusion, SPEM performance is impaired in patients with hepatic encephalopathy in parallel with the degree of neuropsychiatric disturbance: the pathophysiology of these changes is unknown, but retinal, extrapyramidal, and attentional abnor malities are likely to play a role. Treatment status confounds the classificatio n of neuropsychiatric status and should be taken into account when categorizing these patients. Smooth pursuit eye movements (SPEM) are the conjugate movements used to track the smooth trajectory of small dots. Jerky or ’saccadic’ocular pursuit has been reported in patients with cirrhosis, but no formal assessment of SPEM has ever been undertaken. The aim of This study was to evaluate SPEM in patients with ci rhinosis and varying degrees of hepatic encephalopathy. The patient population co mprised 56 individuals (31 men, 25 women) of mean age 51.1 (range, 25-70) years, with biopsy-proven cirrhosis , classified, using clinical, electroencephalogra phic, and psychometric variables, either as neuropsychiatrically unimpaired or as having minimal or overt hepatic encephalopathy; patients were further categori zed in relation to their treatment status. The reference population comprised 28 healthy volunteers (12 men, 16 women) of mean age 47.3 (range, 26-65) years. S PEM was assessed using an electro-oculographic technique. Visual inspection of the SPEM recordings showed clear disr uption of smooth pursuit in the patients wi th minimal hepatic encephalopathy, and more pronounced disruption, if not comple te loss, of smooth pursuit in patients with overt hepatic encephalopathy. The di fferences observed in quantifiable SPE Mindices between the healthy volunteers / u nimpaired patients and those with overt hepatic encephalopathy were significant (P <.05). In con clusion, SPEM performance is impaired in patients with hepatic encephalopathy in parallel with the degree of neuropsychiatric disturbance: the pathophysiology of these changes is unknown, but retinal, extrapyramidal, and attentional abnor malities are likely to play a role. Treatment status confounds the classificatio n of neuropsychiatric status and should be taken into account when categorizing these patients.