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Nystagmus: Causes, Symptoms & Treatment

Nystagmus is an involuntary, rhythmic movement of the eyes that cannot be consciously controlled. It can be congenital or acquired and has various causes.

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Things worth knowing about "Nystagmus"

Nystagmus is an involuntary, rhythmic movement of the eyes that cannot be consciously controlled. It can be congenital or acquired and has various causes.

What is Nystagmus?

Nystagmus is an involuntary, repetitive movement of the eyes that the affected person cannot consciously control. The eye movements may be horizontal (side to side), vertical (up and down), or rotary (circular). In many cases, a slow drifting phase alternates with a rapid corrective movement. Nystagmus can affect one or both eyes and may be constant or occur only in certain situations or gaze directions.

Causes

Nystagmus can be broadly divided into congenital (infantile) and acquired forms.

Congenital Nystagmus

Genetic factors or developmental disorders of the brain
Visual impairment present from birth (e.g., albinism, congenital cataracts)
Idiopathic (no identifiable cause)

Acquired Nystagmus

Disorders of the vestibular system (e.g., labyrinthitis, Meniere disease)
Neurological conditions such as multiple sclerosis, stroke, or brain tumors
Medications and substances (e.g., overdose of antiepileptics, alcohol intoxication)
Vitamin B12 deficiency or other metabolic disorders
Head or brain injuries

Symptoms

The hallmark symptom is the visible, involuntary eye movement. Additional complaints may include:

Blurred or oscillating vision (oscillopsia)
Reduced visual acuity
Dizziness and balance disturbances
Sensitivity to light
Compensatory head posture (to find a so-called null point where eye movement is least pronounced)

Diagnosis

The diagnosis of nystagmus involves a thorough multi-disciplinary evaluation:

Ophthalmologic examination: Assessment of eye movements, visual acuity, and the retina
Electronystagmography (ENG) / Videonystagmography (VNG): Measurement and recording of eye movements
ENT evaluation: Assessment of the vestibular (balance) system
Neurological examination including imaging (MRI, CT) to rule out central nervous system causes
Blood tests if metabolic disorders or vitamin deficiencies are suspected

Treatment

Treatment depends on the underlying cause and the severity of the condition:

Treatment of the Underlying Cause

If nystagmus is triggered by a treatable condition (e.g., labyrinthitis, vitamin deficiency), addressing that cause can significantly reduce or eliminate the nystagmus.

Pharmacological Therapy

Medications such as baclofen, memantine, or gabapentin may help reduce eye movements in selected cases
Botulinum toxin injections in carefully selected patients

Optical Aids and Rehabilitation

Specialized glasses or contact lenses to improve visual acuity
Vision training and low-vision rehabilitation programs

Surgical Treatment

In rare cases, surgery on the eye muscles (a so-called Kestenbaum procedure) can improve the null-point position and reduce the need for a compensatory head tilt.

References

Leigh R.J., Zee D.S. - The Neurology of Eye Movements. 5th edition. Oxford University Press, 2015.
Hertle R.W. - Nystagmus in Infancy and Childhood. American Orthoptic Journal, 2010; 60:1-13. PubMed PMID: 21149158.
Strupp M., Brandt T. - Diagnosis and treatment of vertigo and dizziness. Deutsches Aerzteblatt International, 2008; 105(10):173-180.

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