Definition

Nystagmus is a type of involuntary movement of the eyes. The movement usually alternates between slow and fast and involves both eyes. The direction of movement may be:

• Horizontal—side-to-side
• Vertical—up and down
• Rotatory—circular

Different types of nystagmus are:

• Infantile—tends to develop between ages 6 weeks and 3 months and is the most common type
• Acquired—occurs later in life

Causes

Infantile or motor nystagmus is usually due to instability in the motor system that controls the eyes.

Acquired or sensory nystagmus is usually due to poor vision or neurologic problems.

In some cases, the cause of nystagmus is unknown.

Risk Factors

Factors that may increase your chance of nystagmus include:

• Genetic tendency
• A family member with nystagmus
• Poor development of eye control that may be caused by an eye disease or visual problem during infancy, such as bilateral optic nerve hypoplasia or congenital cataracts
• Lack of pigmentation resulting in reduced vision— albinism
• Eye disorders, such as optic nerve degeneration or severe astigmatism or severe nearsightedness
• Health conditions, such as Menieres disease which involves balance problems, multiple sclerosis, spasmus nutans, or stroke
• Injury to the head or involving the body’s motor system
• Use of certain medications, such as lithium or antiseizure medications
• Alcohol use disorder or drug abuse
• Inner ear problems, such as infections, irritation, or benign paroxysmal positional vertigo
• Thiamine or vitamin B12 deficiency
• Conditions that affect the brain, such a tumor

Symptoms

Nystagmus may cause:

• Sensitivity to light
• Difficulty seeing in darkness
• Vision problems
• Head held in a turned or tilted position
• Oscillopsia—feeling that the world is shaking or moving
• Vertigo

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. If nystagmus seems to be present, you may need:

• A full exam with an eye specialist called an ophthalmologist
• An ear exam, including a hearing test
• Exam with a neurologist or other medical specialist

Tests may include the following:

• Visual exam of the inside of the eye with an ophthalmoscope
• Vision testing
• Eye movement recordings

Imaging tests may include:

• CT scan
• MRI scan

MRI Scan

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The ophthalmologist will also look for other eye problems that may be related to the nystagmus, such as strabismus, cataracts, or abnormality of the optic nerves or retina.

The ear specialist will look for signs of ear infection, and for worsening of the nystagmus with head positions.

Treatment

Talk with your doctor about the best treatment plan for you. Removal of the cause of nystagmus can sometimes eliminate the problem, such as discontinuing a medication or stopping alcohol or drug use. However, nystagmus often is a permanent condition that can only be reduced and not eliminated. Treatment options to reduce nystagmus and improve vision include the following:

• Prisms, tints, eyeglasses, or contact lenses
• Adopting a particular angle of vision where the nystagmus is reduced, such as holding the head in a certain position
• Vibratory stimulation of the face and neck
• Certain medications for specific types of nystagmus, including botox injections to relax the eye muscles, muscle relaxants, and certain antiseizure medications
• Surgery on the eye muscles

Low-vision aids can often help improve vision. They may include large print or high contrast materials, good lighting, and magnifying devices.

Prevention

There are no current guidelines to prevent nystagmus.