Smooth pursuit eye movements (SPEMs) of 11 bipolar manic patients were impaired during lithium treatment, which, however, improved their clinical condition. SPEM impairment was evident in a general qualitative degradation of eye tracking integrity, in a tendency for gain to be lowered, and in an increase in the number of saccadic events. Individual differences in the nature and magnitude of effects of lithium on eye movements were noteworthy.