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Background: oculomotor dysfunction is one of the most stable markers of schizophrenia. At the same time, the attention of researchers is mainly focused on the characteristics of macro eye movements in nervous and mental disorders, while the features of micro eye movements, in particular ocular microtremor (OMT) generated by the oscillators of the brainstem and cerebellum, poorly understood. The aim was to study the potential of OMT as a marker for objective assessment of changes in the functional state of patients with schizophrenia spectrum disorders. Patients, Participants and Methods: the study involved 30 healthy subjects, 47 patients with paranoid schizophrenia, 27 patients with schizotypal disorder and 20 patients with schizoaffective disorder. Instrumental recording of OMT was performed using the super–slow motion video recording method. Average values of OMT frequency and amplitude were calculated, as well as the frequency of OMT frequency values falling within the intervals of 0–40 Hz, 40–50 Hz, 50–60 Hz, 60–70 Hz, 70–100 Hz, 100–110 Hz and the average OMT amplitude in each frequency range. Results: patients differed from the healthy control group by a decrease in the high–frequency component (70–110 Hz) in the OMT spectrum with a simultaneous increase in the proportion of the low–frequency component (40–60 Hz). Intragroup comparison of OMT frequency indicators at the time of inclusion in the study and showed that significant changes were observed only in the group of patients with schizophrenia in the average OMT frequency and in the frequency of OMT frequency falling within the ranges of 60–70 Hz and 70–100 Hz after 8 weeks of antipsychotic therapy. Significant changes in the OMT amplitude during therapy were also observed only in the group of patients with schizophrenia and in the low–frequency component of the OMT. The average values of the OMT amplitude were higher in the groups of patients, regardless of their condition, compared with the values of the OMT amplitude in the healthy control. Conclusion: the potential of using OMT recording to assess the dynamics of the functional state in schizophrenia spectrum disorders can carry important, missing information about the neurophysiological mechanisms of the disease and serve as a tool for differential diagnosis and assessment of the dynamics of the condition.