Nystagmus

What is nystagmus?

Nystagmus is a condition where eyes make rapid, repetitive, uncontrolled movements. Eyes may move in different directions:

• Side to side (horizontal nystagmus).
• Up and down (vertical nystagmus).
• In a circle (rotary or torsional nystagmus).

The movements can follow different patterns. Eyes may:

• Drift in one direction and then jerk in the opposite direction to correct (jerk nystagmus).
• Drift back and forth in a steady, pendulum-like motion (pendular nystagmus).

These eye movements may cause problems with Vision, depth perception, balance and coordination.

Types of nystagmus

Nystagmus affects both children and adults. There are two types: congenital or infantile (onset at birth or in the first few months of life) and acquired (onset after 6-9 months of age).

Congenital or infantile nystagmus

Babies born with nystagmus usually show symptoms between 6 weeks and 3 months of age. Sometimes, parents pass nystagmus on to their children, but the exact cause is not always clear. Children with congenital nystagmus often have it in both eyes. Their eyes usually move side to side. The main symptom is blurry vision.

Acquired nystagmus

Acquired nystagmus develops later in life and is more common in adults. Nystagmus may be a symptom of a medical condition affecting the brain, eyes or ears. Or, it may not be related to a condition at all. It may just be how the body works. Sometimes nystagmus results from alcohol and drug use. Adults with acquired nystagmus often describe their vision as shaky.

Spasmus nutans is a form of acquired nystagmus that affects children. It’s usually diagnosed between 6 months and 3 years old. This type of nystagmus usually improves without treatment between ages 2 and 8.

How common is nystagmus?

Anywhere from 6 to 36 people out of every 10,000 have some type of nystagmus.

Is nystagmus a serious condition?

Nystagmus by itself is not dangerous. But it may be associated with serious health conditions, especially those affecting the brain, such as stroke, brain tumor, toxicity, head trauma (injury) and inflammatory diseases.

Symptoms of nystagmus:

The biggest sign of nystagmus is uncontrollable movement with the eyes. The symptoms of nystagmus depend on the condition causing it and include:

• Feeling as if surroundings are moving (Oscillopsia).
• Shaky or blurry vision.
• Balance problems.
• Light sensitivity or trouble seeing in the dark.
• Dizziness or feeling like world is spinning, VERTIGO.

What causes nystagmus?

The  brain controls eye movement in conjunction with the structures in the ear, called the vestibular system. It automatically adjusts eyes when one moves the head so that the image one sees remains in focus. In people with nystagmus, a problem is preventing the brain, the vestibular system and eyes from working together as a Team.

Nystagmus may indicate another eye problem, a neurological condition or a problem with the parts of inner that control balance and coordination.

Nystagmus causes and risk factors include:

• Developmental problems with the brain or eye.
• Retinal Disorders
• Benign paroxysmal positional vertigo (BPPV) and Meniere's disease
• Stroke
• Brain tumor.
• Eye or head trauma (injury).
• Alcohol or drug use.
• Albinism
• Astigmatism
• Certain medications, such as antiseizure drugs.
• MS
• Strabismus and Cataracts

Sometimes, it may be called Idiopathic nystagmus, when no other cause can be identified.

An eye care specialist typically diagnoses nystagmus. An Eye Exam is performed and symptoms are reviewed and analyzed. Eye problems related to nystagmus, including strabismus, cataracts or issues with retina or optic nerve have to be ruled out. Neurologists and Otorhinolaryngologists can also diagnose nystagmus and test the Brain or inner ear for conditions that may be causing it.

Tests to diagnose nystagmus

You may need additional tests with different providers to learn what’s causing nystagmus. An Eye Doctor may perform tests to see if an eye disease is causing nystagmus. A Neurologist may perform tests to see if a brain condition is causing nystagmus. An Ear Doctor may test to see if the  nystagmus is related to an inner ear condition.

Tests may include:

• A Neurological exam.
• An Ear exam.
• Eye movement recordings 
• Imaging , such as CT Scan and MRI
• Gene to identify inherited mutations that may be associated with some forms of congenital nystagmus.

The correction of nystagmus depends on the medical condition responsible for it.

Sometimes, treating the underlying condition can correct acquired nystagmus. For example, treating an inner ear condition causing nystagmus can improve symptoms like shaky vision or dizziness. In some conditions, the brain and vestibular system compensate for the damage, and nystagmus goes away or decreases over time.

Certain types of congenital nystagmus may disappear later in life. Other types cannot be cured completely, but proper treatment can manage symptoms.

What are the treatments for Nystagmus?

Your HCP will recommend treatment based on what is causing the Nystagmus. 

Glasses or contact lenses

Clearer vision can help slow the rapid eye movements associated with nystagmus. Your provider may recommend Prescription Eyeglasses to manage symptoms. One may need prism lenses, which regulate how much the eyes must move in order to see clearly.

Medications

Some medications can reduce nystagmus symptoms in adults, such as Botox, Gabapentin and Baclofen. 

Eye Muscle Surgery

In some cases, HCP may recommend Strabismus Surgery, where in a surgeon repositions the muscles that move the eyes. This surgery does not cure nystagmus, but it may improve eye movement. 

Symptoms can be reduced  by treating the underlying cause.

Nystagmus can make everyday tasks more challenging. Sometimes, it limits the types of jobs and hobbies that one can have.

Nystagmus rarely goes away completely, but it can improve over time. Consult your HCP, ECP or Neurologist about this condition.