Nystagmus

Nystagmus is defined as involuntary rhythmic oscillations of the eyes. The finding is usually bilateral, and the abnormal movements occur identically in both eyes. Ophthalmologists distinguish between types of nystagmus by the direction of the eye movements; they may be rotatory, horizontal or vertical, or jerky and are described in the direction of fast phase and slow phase of the eye movements.

Differential Diagnosis

• Nystagmus occurs at the extreme lateral gaze in many normal individuals
  –May also occur when tracking an object or row of objects horizontally
  –Can be induced by rotatory visual stimuli or otic irrigation (vestibular stimuli) in normal individuals
• Hereditary nystagmus
  –Benign condition of horizontal nystagmus
  –May not be accompanied by other neurologic findings, but involuntary head-bobbing may be a feature
  –May be XL or AD
• Visual impairment
  –Poor vision, ocular blindness, and cortical blindness can result in nystagmus
  –May also have “searching” eye movements that are not true nystagmus
  –Both are more likely to occur in patients born blind or blind from an early age
• Spasmus mutans
  –May be isolated or associated with intracranial mass
  –Characterized by nystagmus, involuntary head-bobbing, and torticollis
• Congenital jerking nystagmus
  –Idiopathic; horizontal nystagmus with lateral gaze on one direction
• Intracranial neoplasms
• Arnold-Chiari malformation
• Cerebellar etiologies
  –Acute cerebellar ataxia
  –Encephalitis or abscess involving the cerebellum
• Septo-optic dysplasia
  –Optic nerve hypoplasia, associated with other midline brain defects
  –Endocrine abnormalities are common (diabetes insipidus, hypoglycemia, hypopituitarism, failure to thrive)
• Toxicity
  –Medications include barbiturates, hydantoin, antihistamines, and salicylates
  –Lead toxicity
  –Alcohol intoxication may involve vestibular disturbances including vertigo, nystagmus
  • Opsoclonus
    –Not true nystagmus
    –Eye movements that may be mistaken for nystagmus (e.g., opsoclonus-myoclonus disorder)

Workup and Diagnosis

• History
  –Onset, duration, progression
  –Accompanying signs and symptoms, including symptoms of intracranial space-occupying lesion such as headache and vomiting
  –Family history
  –Birth and past medical history
• Physical exam
  –Characterization of the eye movements that elicit nystagmus, the severity, and the type of eye movements
  –Visual acuity in each eye
  –Funduscopic examination for papilledema
  –Extraocular muscle evaluation
  –Pupillary red light reflex: White in retinoblastoma
  –Preferred head position: Patients with congenital jerking nystagmus frequently turn their faces in such a way as to minimize nystagmus
  –Positional test for benign paroxysmal vertigo
  –Head circumference (hydrocephalus)
  –Neurologic examination including cranial nerves and cerebellar signs

• Labs
  –Toxicology screen and medication levels as applicable
• Studies
  –Imaging of the brain may be required to rule out malignancy, mass, midline defects

Treatment

• Normal and hereditary nystagmus do not require treatment, only reassurance
• Visual impairment: Nystagmus is diminished with optimization of visual acuity
• Spasmus mutans does not itself require treatment; evaluation for intracranial mass is essential
• Arnold-Chiari malformation: Surgical correction
• Acute cerebellar ataxia: Ataxia, nystagmus, and vomiting follow a viral illness; may represent an autoimmune response; slow spontaneous recovery is the norm, some patients have neurologic sequelae
• Septo-optic dysplasia: Nystagmus is not treatable; patients require support for associated disease
• Toxicity: Adjustment of medication levels, lead decontamination, avoidance of alcohol

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Nystagmus

Read excerpts from these other book chapters related to Nystagmus:

Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Nystagmus

• Back to symptom: Nystagmus: Introduction (review 375 causes)
• Next Book Extract About Nystagmus: EYE PAIN (Differential Diagnosis in Primary Care)
• All Book Extracts: All Online Book Extracts for Nystagmus

More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

 » Next page: EYE PAIN (Differential Diagnosis in Primary Care)

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• NYSTAGMUS (Differential Diagnosis in Primary Care)
• Eye pain (Handbook of Signs & Symptoms (Third Edition))
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• Nystagmus (Handbook of Signs & Symptoms (Third Edition))

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