Background: Isolated down-gaze palsy is the least common pathology of vertical gaze. Patients with low-gaze palsy may consult an ophthalmologist with difficulty in reading and this may be the only ocular finding of a central nervous system lesion. Methods: A 43-year-old man with isolated down-gaze palsy was examined. The medical history of the patient revealed that he had had myocardial infarction. Result: Magnetic resonance imaging disclosed an ischemic area at the right thalamus. Conclusion: Down-gaze palsy may be an important sign for the diagnosis of thalamic infarctions due to embolic syndrome.