Involuntary Eye Movements
Nystagmus is rapid, uncontrollable eye movements. If you have nystagmus, your eyes may move up and down, side to side or in a circular motion. Sometimes people are born with it (congenital nystagmus), but you can also develop it later in life (acquired nystagmus). Glasses, contact lenses, medications and surgery are potential treatments.
What is nystagmus?
Nystagmus (pronounced “ni-STAG-muhs”) is a condition where your eyes make rapid, repetitive, uncontrolled movements. Your eyes may move in different directions:
- Side to side (horizontal nystagmus).
- Up and down (vertical nystagmus).
- In a circle (rotary or torsional nystagmus).
The movements can follow different patterns. Your eyes may:
- Drift in one direction and then jerk in the opposite direction to correct (jerk nystagmus).
- Drift back and forth in a steady, pendulum-like motion (pendular nystagmus).
These eye movements can cause problems with vision, depth perception, balance and coordination.
Types of nystagmus
Nystagmus affects both children and adults. There are two types: congenital or infantile (onset at birth or in the first few months of life) and acquired (onset after 6 months of age).
Congenital or infantile nystagmus
Babies born with nystagmus usually show symptoms between 6 weeks and 3 months of age. Sometimes, parents pass nystagmus on to their children, but the exact cause isn’t always clear. Children with congenital nystagmus often have it in both eyes. Their eyes usually move side to side. The main symptom is blurry vision.
Acquired nystagmus
Acquired nystagmus develops later in life and is more common in adults. Nystagmus may be a symptom of a medical condition affecting your brain, eyes or ears. Or, it may not be related to a condition at all. It may just be how your body works. Sometimes nystagmus results from alcohol and drug use. Adults with acquired nystagmus often describe their vision as shaky.
Spasmus nutans is a form of acquired nystagmus that affects children. It’s usually diagnosed between 6 months and 3 years old. This type of nystagmus usually improves without treatment between ages 2 and 8.
How common is nystagmus?
Researchers don’t know for sure how many people in the general population have nystagmus. Previous studies have reported that anywhere from 6 to 24 people out of every 10,000 have some type of nystagmus.
Is nystagmus a serious condition?
Nystagmus itself isn’t considered dangerous. But it may be associated with serious health conditions, especially those affecting your brain, such as stroke, brain tumor, toxicity, head trauma (injury) and inflammatory diseases.
What causes nystagmus?
Your brain controls eye movement in conjunction with the structures in your ear, called the vestibular system. It automatically adjusts your eyes when you move your head so that the image you see remains in focus. In people with nystagmus, a problem prevents your brain, the vestibular system and your eyes from working together.
Nystagmus could indicate another eye problem, a neurological condition or a problem with the parts of your inner ear that control balance and coordination.
Nystagmus causes and risk factors include:
- Developmental problems with your brain or eye.
- Retina or optic nerve disorders.
- Inner ear disorders, such as benign paroxysmal positional vertigo (BPPV) and Ménière’s disease.
- Stroke.
- Brain tumor.
- Eye or head trauma (injury).
- Alcohol or drug use.
- Albinism (lack of pigmentation in the skin).
- Vision problems, including nearsightedness or astigmatism.
- Certain medications, such as antiseizure drugs.
- Diseases affecting your central nervous system, like multiple sclerosis (MS).
- Eye problems in babies, including strabismus (crossed eyes), focusing issues and cataracts.
Sometimes, there isn’t a clear cause. This is called idiopathic nystagmus.
What are the symptoms of nystagmus?
The biggest sign of nystagmus is uncontrollable movement in your eyes. The symptoms of nystagmus depend on the condition causing it and include:
- Feeling as if your surroundings are moving (oscillopsia).
- Shaky or blurry vision.
- Balance problems.
- Light sensitivity or trouble seeing in the dark.
- Dizziness or feeling like you’re spinning (vertigo).
omplications of osteogenesis imperfecta can include:
- Heart disease, including heart failure.
- Frequent pneumonia.
- Respiratory issues, including respiratory failure.
- Nervous system issues.
How is nystagmus diagnosed?
An eye care specialist called an ophthalmologist typically diagnoses nystagmus. They’ll perform an eye exam and ask about your symptoms. They’ll check for eye problems related to nystagmus, including strabismus, cataracts or issues with your retina or optic nerve. Other specialists, such as brain doctors (neurologists) and ear doctors (otorhinolaryngologists), can also diagnose nystagmus and test you for brain or inner ear conditions causing it.
Tests to diagnose nystagmus
You may need additional tests with different providers to learn what’s causing nystagmus. An ophthalmologist may perform tests to see if an eye disease is causing nystagmus. A neurologist may perform tests to see if a brain condition is causing nystagmus. An otorhinolaryngologist or audiologist may test to see if nystagmus relates to an inner ear condition.
Tests may include:
- A neurological exam.
- An ear exam.
- Eye movement recordings (such as electronystagmography and video-nystagmography).
- Imaging tests to capture pictures of your brain, such as CT scan (computed tomography scan) or MRI (magnetic resonance imaging).
- Genetic tests to identify inherited genetic mutations (errors in your DNA) associated with some forms of congenital nystagmus.
Can nystagmus be corrected?
The correction of nystagmus depends on the medical condition responsible for it.
Sometimes, treating the underlying condition can correct acquired nystagmus. For example, treating an inner ear condition causing nystagmus can improve symptoms like shaky vision or dizziness. In some conditions, your brain and vestibular system compensate for the damage, and nystagmus goes away or decreases over time.
Certain types of congenital nystagmus may disappear later in life. Other types can’t be cured completely, but proper treatment can manage symptoms.
What are the treatments for nystagmus?
Your healthcare provider will recommend treatment based on what’s causing your nystagmus. They’ll also consider your health history and personal preferences.
Glasses or contact lenses
Clearer vision can help slow the rapid eye movements associated with nystagmus. Your provider may recommend eyeglasses or contact lenses to manage symptoms. You may need prism lenses, which limit how much your eyes must move to see clearly.
Medications
Some medications can reduce nystagmus symptoms in adults, such as gabapentin (antiseizure), baclofen (muscle relaxant) and onabotulinumtoxina (Botox®). Your healthcare provider will determine whether you would benefit from any medications.
Eye muscle surgery
In rare instances, your provider may recommend strabismus surgery. During this procedure, a surgeon repositions the muscles that move the eyes. This surgery doesn’t cure nystagmus, but it improves your eye movement. You won’t have to tilt or turn your head as much to see clearly.
Vision correction surgery
If you have nystagmus and are nearsighted, you may benefit from laser vision correction surgery — such as LASIK. Laser eye surgery doesn’t cure nystagmus, but it improves your vision. Improved vision can reduce your nystagmus symptoms.
What can I expect if I have nystagmus?
Nystagmus can make everyday tasks more challenging. Sometimes, it limits the types of jobs and hobbies you can have.
Nystagmus rarely goes away completely, but it can improve over time. Your healthcare provider can help you find a treatment that works for you.
How can I prevent nystagmus?
Currently, there’s no way to prevent nystagmus. But you can reduce symptoms by treating the underlying cause.
When should I see my healthcare provider?
Contact your healthcare provider immediately if you notice any changes in your vision or have difficulties with balance or coordination. Remember that nystagmus can be a symptom of serious health issues. Prompt diagnosis and treatment are essential.
If you’ve already been diagnosed with nystagmus, inform your provider if your symptoms worsen.
References
- American Academy of Ophthalmology. What Is Nystagmus? (https://www.aao.org/eye-health/diseases/what-is-nystagmus) Accessed 10/4/2023.
- Choi JH, Kim SJ, Thomas MG, et al. Diagnostic yield of targeted next-generation sequencing in infantile nystagmus syndrome (https://pubmed.ncbi.nlm.nih.gov/34132631/). Ophthalmic Genet. 2021;42(5):561-569. Accessed 10/4/2023.
- Kates MM, Beal CJ. Nystagmus (https://pubmed.ncbi.nlm.nih.gov/33620408/). JAMA. 2021;325(8):798. Accessed 10/4/2023.
- Rucker JC and Lavin P.J.M. Neuro-ophthalmology: Ocular Motor System. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff’s Neurology in Clinical Practice. 8th edition. Elsevier, 2022: 201-240.
- Sekhon RK, Rocha Cabrero F, Deibel JP. Nystagmus Types (https://www.ncbi.nlm.nih.gov/books/NBK539711/). 2023 Feb 27. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Accessed 10/4/2023.
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