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Definition  

Nystagmus is a type of involuntary movement of the eyes. The movement varies between slow and fast and usually involves both eyes.

Different types of nystagmus are:

  • Horizontal—side-to-side
  • Vertical—up and down
  • Rotatory—circular
  • Infantile—tends to develop between 6 weeks and 3 months of age
  • Acquired—occurs later in life
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Causes  

The direct cause of nystagmus is instability in the motor system that controls the eyes. In some cases, the cause of nystagmus is unknown.

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Risk Factors  

Factors that may increase your chance of nystagmus include:

  • Genetics
  • 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— albinism
  • Eye disorders, such as optic nerve degeneration or severe astigmatism or severe nearsightedness
  • Health conditions, such as Meniere’s 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 abuse or drug use
  • Inner ear problems, such as infections, irritation, benign paroxysmal positional vertigo, some brain tumors
  • Thiamine or vitamin B12 deficiency
  • Health condition that can also affects the brain
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Symptoms  

Nystagmus may cause:

  • Sensitivity to light
  • Difficulty seeing in darkness
  • Vision problems
  • Head held in a turned position
  • Oscillopsia—feeling that the world is shaking or moving
  • Vertigo
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Magnetic Resonance Imaging  
MRI of the Brain

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Diagnosis  

Your doctor will ask 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:

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.

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Treatment  

Talk with your doctor about the best treatment plan for you. Removal of the cause of nystagmus can sometimes eliminate the problem, for example 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 certain types of nystagmus, including botox injections to relax the eye muscles, muscle relaxants, and certain anti-seizure 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.

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Prevention  

There are no current guidelines to prevent nystagmus.