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Nystagmus: Causes, Symptoms & Effective Treatment

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Nystagmus is the most common issue causing visual impairment in children, and it affects approximately 1 in 1,000 people. Certain types are more common in one sex over the other, but both men and women can be affected.

This condition is a complex eye condition that causes involuntary eye movements. It can be present at birth or acquired later in life.

It is important that people get a definitive diagnosis, so a doctor can provide a proper treatment regimen. This includes a comprehensive eye examination.

There are many treatments that can help people with nystagmus. This includes both surgical and medical options. Some people may benefit from using several treatment methods, while others might only need one to reduce their symptoms.

Nystagmus Types

In most cases, people develop nystagmus at a young age. There are five primary types of nystagmus.

nystagmus diagram
  • Manifest nystagmus: With this type, the symptoms are present at all times.
  • Latent nystagmus: With this type, the symptoms only occur when the person covers one of their eyes.
  • Manifest-latent nystagmus: With this type, the symptoms are always there, but when the person covers one eye, the symptoms get worse.
  • Congenital nystagmus: This is a type of nystagmus that is present when a person is born.
  • Acquired nystagmus: With this type, there is an underlying disease that causes the problem, such as multiple sclerosis, diabetic neuropathy, a brain tumor, or a head injury.

Nystagmus Symptoms

Uncontrollable rapid eye movements are the most common symptom of this condition. In most cases, the eyes move from side to side. However, there are times when the movement is circular or up and down. Both eyes are usually affected. The movement can be fast, slow, or transfer back and forth between the two.

There are other possible symptoms.

  • Dizziness
  • Vision issues
  • Needing to hold the head in a tilted or turned position
  • Light sensitivity
  • Trouble seeing when it is dark
  • The sensation that the world is shaking

Nystagmus Causes

Nystagmus usually results from a neurological issue that occurs early in life or is present at birth. However, some types of this condition are acquired. This means that a person could develop them later in life.

In some cases, nystagmus is a symptom of an underlying condition, such as a stroke, trauma, or multiple sclerosis.

Other possible causes of nystagmus include:

  • Children may not develop normal eye movements early in life.
  • Astigmatism, nearsightedness, or a very high refractive error.
  • Inner ear inflammation.
  • Central nervous system diseases.
  • Albinism
  • Congenital cataracts.
  • Anti-epilepsy drugs and certain other medications.

Diagnosing Nystagmus

The first step to diagnosing is a full physical examination, with the doctor focusing on the inner ear and nervous system. Learning more about the person’s medical history is also important since certain conditions can cause nystagmus.

For part of the exam, the patient usually wears special goggles that magnify the eyes.

Neurological Testing

If the person has a medical condition that can cause nystagmus, specific tests might be done that focus on this. For example, the doctor may do additional neurological testing if the person has multiple sclerosis.

The doctor will evaluate the person’s eyes and how they move. One popular exam is a spin test.

The patient will spin around for approximately 30 seconds. Once stopped, they stare at one object. The doctor looks at the patient’s gaze and any involuntary eye movements that occur. In particularly, the doctor looks to see if the person’s eyes move slowly in one direction and then quickly in the other direction.

Vestibular Testing

The doctor might also order vestibular testing. Several vestibular test options are available, including:

  • Videonystagmography (VNG) or electronystagmography (ENG): This evaluates the inner ear.
  • Computerized dynamic visual acuity: This reveals how vestibular issues could be impacting vision during everyday events, such as turning their head or taking a walk.
  • Rotary chair test: This can determine if nystagmus stems from a brain or inner ear disorder.
  • Subjective visual vertical: This is an examination a specific inner ear organ referred to as the utricle. It helps to see if a person’s nystagmus comes from an inner ear injury, vestibular neuritis or if certain nerves were injured.
  • Computerized dynamic posturography: This evaluates vestibular, sensory, and visual systems during balance.
  • Vestibular evoked myogenic potential: This gauges whether the vestibular nerve and the saccule are working properly.

Other Tests

Doctors can order more tests if initial nystagmus tests prove inconclusive. Other diagnostics can include:

  • Electronstagmography. This is done to record eye movements when the person is still. Electrodes are placed on the head to examine the person’s lateral eye movements.
  • Head CT scan. This test gains a better look at the structures of the brain and head. The person will lie on a table, and their head is usually put into a holder to ensure they are still. In some cases, the doctor may want to use a contrast dye for better visualization.
  • Head MRI. This imaging tests gets pictures of the person’s nerve tissues and brain. The doctor may use a contrast dye to get clearer photos of certain areas. No radiation is used during an MRI. This test takes an average of 30 to 60 minutes.

Treatment Options for Nystagmus

An opthamologist is listening to the patient in an exam room.
The treatment that a doctor recommends generally depends on the type of nystagmus a person has and if there is an underlying cause. Some people may benefit from corrective lenses. While these do not directly treat nystagmus, they can help with other vision issues, such as nearsightedness. Correcting other vision problems may make living with nystagmus a little easier.

Surgery is not often performed, but some people may benefit from a procedure called strabismus surgery. The goal of this procedure is to reduce abnormal head positioning or to reduce nystagmus amplitude. This procedure usually does not completely eliminate nystagmus, but it could result in some vision improvement.

Another possible surgical option is called a tenotomy. Research shows that this procedure may broaden the null zone, improve visual acuity, and improve target acquisition. The procedure that was studied was the four-muscle tenotomy. The improvements that the researchers observed were when the person was in the primary position.

Botox may offer temporary relief from nystagmus symptoms. This is an injectable that can paralyze a muscle temporarily. By paralyzing the right muscles, it could potentially reduce a person’s involuntary eye movements. If Botox does work, the person would need to have it injected two or more times a year to continue reaping the benefits.

Medications may be helpful for some people. The type of nystagmus a person has dictates which medications might be helpful.

  • Downbeat nystagmus: 3,4-diaminopyridine, 4-aminopyridine, or clonazepam
  • Torsional nystagmus: gabapentin
  • Acquired pendular nystagmus: memantine, gabapentin, or trihexyphenidyl
  • Seesaw nystagmus: clonazepam, alcohol, or memantine
  • Upbeat nystagmus: 4-aminopyridine, memantine, or baclofen
  • Acquired periodic alternating nystagmus: memantine or baclofen
  • Infantile nystagmus: memantine, topical brinzolamide, gabapentin, or acetazolamide

These medications may not be effective for all people. It could take some trial and error to determine which medications at which doses are beneficial for a particular person. These may be combined with other treatments.

For most people with congenital nystagmus, there are no treatment options. The doctor works with the patient and their parents to determine if supportive care could be beneficial for improving the person’s quality of life.

There are cases where nystagmus resolves on its own. This is typically when someone has acquired nystagmus due to a medical condition. Treating the underlying condition could resolve the nystagmus.

While there is no cure for this condition, treatments methods can be beneficial for many people. This is true for both adults and children who have the condition.

As soon as nystagmus is suspected, it is important to see an eye doctor to get a definitive diagnosis.

Tips for Living with Nystagmus

Given that most cases of nystagmus are untreatable, it helps to learn how to live with it, especially in the case of kids. Here are some tips for living with the condition.

Optimize Computer Monitors

When using the computer, tailor the features to optimize your viewing. You can adjust the color, brightness and font size of the text to make reading easier. Considering you may be spending up to four hours a day in front of a screen, making these adjustments will improve your vision and your working/viewing experience.

Add More Light

You can also seek to have additional lighting like a reading lamp to provide extra aid to your vision and combat the blurriness. The idea is to counter the viewing challenges and improve your eyesight even with eye movements.

Make Sure Eye Prescriptions Are Up to Date

Glasses and contact lenses help correct some of the eye conditions associated with nystagmus, which can include refractive errors. You will need an annual eye exam, and your doctor will advise you on any changes you need to make. Should you experience a change in your condition, you do not have to wait for the annual exam.

Read with a Line Marker

If you are in school or doing the usual reading, use a line marker, a guided eye lighter, or a reading strip to keep track of your place. It also helps you read faster.

Take Frequent Breaks

Nystagmus will leave you feeling fatigued often, which may worsen the condition. Thus, when reading, take frequent breaks, whether it is an eBook or physical material.

Protect Your Eyes from Glare

Whether you are indoors or outdoors, use tinted glasses to protect your eyes from glare. When working with a computer screen, you can get specialized anti-glare glasses.

Make Use of Low-Vision Aids

You can make most of the other low vision aids, including magnifiers for learning and reading.

Let Others Help You

Let people you are with understand your challenges, especially when you are outdoors, so they can anticipate any issues and look out for you. You should also account for your difficulty with perception with depth whenever you are out.

Prevent Triggers to Nystagmus

Nystagmus can vary in its intensity even over the course of a day, and certain triggers can make it worse, so you should avoid them. Common triggers include stress, fatigue, excitement and illness.
Let Teachers and Schools Know

If your child has nystagmus, you should make an effort to make sure their school and teachers know about it. It helps if the teacher recognizes your child’s challenges, including picking up facial expressions and his body language.

In some cases, schools may have to provide accommodations under the law. Such as:

  • Individual worksheets
  • Special positioning in the classroom that makes the most of their null point

Technology for Reading

Employ all accessible technology to help with work and study, like speech-to-text software, audiobooks, and others to help you or your child read and write with ease.

Find Appropriate Sports and Play Areas

Children with nystagmus need to have quieter play spaces, and new environments can cause anxiety necessitating the need for auditory and pre-visual explanations.

Bilateral Nystagmus

Some types of nystagmus affect only one eye, while others affect both eyes. When both eyes shake, this is called bilateral nystagmus.

As early as 1908, bilateral nystagmus was considered the most common type, or the “true” nystagmus, with equal, simultaneous, horizontal movements in the eyes. Vertical nystagmus, rotary nystagmus, and mixed nystagmus are much rarer.

Causes of Bilateral Nystagmus

The most common cause of bilateral nystagmus, in general, is a vascular disease. This may include:

  • A stroke
  • Antiseizure medications
  • Head or eye trauma that damages the blood vessels

Your vision can be seriously impacted in some cases. In others, you may not notice nystagmus because your body develops it as a vision coping mechanism, especially with bilateral nystagmus. This can be one of several other symptoms you experience, which indicate a severe underlying medical condition that requires help.

Types and Terms of Bilateral Nystagmus

There are two basic types of bilateral nystagmus.

  • Conjugate: This is when both eyes have the same movement, as though they are synchronized.
  • Dissociated: This occurs when both eyes move rapidly back and forth but differently.

There are also two basic terms for the rhythm of the eyes in nystagmus.

  • Pendular: This means that the movements back and forth have the same velocity.
  • Rhythmic: This is when the movement is slower in one direction and faster or jerkier in the other.

It’s possible to have a combination of these. For example, you may have pendular conjugate nystagmus – or rhythmic dissociated nystagmus.

While some ophthalmologists diagnose bilateral vs. unilateral nystagmus, the medical community also believes that it is possible that “unilateral” only indicates asymmetric nystagmus, with one eye more affected than the other, but both eyes still affected by the condition.

Vertical Nystagmus

Some severe conditions may cause vertical, rather than horizontal, nystagmus. These include the following:

  • Intoxication
  • Multiple sclerosis
  • Spasmus nutans
  • Lesions in some areas of the brain
  • Encephalitis lethargica

Frequently Asked Questions

Can nystagmus be corrected?

Nystagmus cannot be corrected, and no cure exists. However, there are a few treatments ranging from surgery to medication that try to manage specific symptoms associated with nystagmus to improve your vision. The use of these treatment methods depends on the diagnosis of your condition.

Is nystagmus serious?

Nystagmus is generally not life-threatening, especially if it is congenital nystagmus. But it could be a symptom of an underlying life-threatening condition like severe head trauma, stroke or multiple sclerosis.

Even when it is not life-threatening, its effect on your depth and distance perception can pose serious safety issues.

What kind of a doctor do you see for nystagmus?

The first doctor to see is an ophthalmologist. (Note, this is not an optometrist.) An ophthalmologist can provide all the basic eye care and diagnosis you get from the optometrist and is licensed to perform all various corrective procedures.

References

  1. Nystagmus. Nystagmus Network.
  2. A Guide to Nystagmus. All About Vision.
  3. Nystagmus Symptoms. American Academy of Ophthalmology.
  4. Nystagmus. American Optometric Association.
  5. Nystagmus. MedlinePlus.
  6. CT Scan of the Head/Brain. Cedars-Sinai.
  7. Head MRI. MedlinePlus.
  8. Common Vestibular Function Tests. American Physical Therapy Association.
  9. Four-Muscle Tenotomy Surgery for Nystagmus. (September 2014). Current Opinion in Ophthalmology.
  10. Nystagmus Treatment. (February 6, 2019). American Academy of Ophthalmology.
  11. Treatment of Nystagmus. (February 2012). Current Treatment Options in Neurology.
  12. Coordination and Cerebellar Testing. (2018). Evidence-Based Physical Diagnosis (Fourth Edition), Science Direct.
  13. Acquired Nystagmus. (October 2018). Medscape.
  14. Downbeat Nystagmus: Characteristics and Localization of Lesions. National Institutes of Health (NIH).
  15. Nystagmus (Jerky Horizontal). (January 2018). GP Notebook.
  16. Nystagmus. (October 2019). American Association for Pediatric Ophthalmology and Strabismus.
  17. 9 Tips for Living with Nystagmus . (March 2019). Everydaysight.com.
  18. 7 tips for nystagmus success in the classroom. (June 2019). Parenta.

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