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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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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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