What Can Cause Nystagmus?

Certain congenital problems, medications, head injuries, neurological disorders, and other conditions may cause nystagmus, or repetitive tics of the eyes that compromise vision.

Nystagmus is a condition in which the eyes make involuntary, repetitive movements, causing visual difficulty. The eye movements may occur from side to side, up and down, or in a circular pattern.

Forms of nystagmus include:

• Infantile
  • Develops in infants 2 to 3 months of age
  • Eyes usually move in a horizontal swinging fashion
  • Often associated with other medical conditions, such as albinism, congenital absence of the iris (the colored part of the eye), underdeveloped optic nerves, and congenital cataracts
• Spasmus nutans
  • Tends to occur between 6 months to 3 years of age 
  • Improves on its own between 2 to 8 years of age
  • Eyes can move in any direction
  • Usually does not require treatment
• Acquired
  • Develops later in childhood or adulthood
  • The cause is frequently unknown

Symptoms of nystagmus include: 

• Involuntary, uncontrolled eye movements
  • Movement may occur in one or both eyes
  • Movement may be up or down, side to side, or circular 
  • Movement may be slow or fast
  • Objects may appear shaky (oscillopsia)
  • Blurred vision
• Nighttime vision problems 
• Sensitivity to light
• Vertigo (spinning sensation) 
• Balance problems
• Dizziness
• Abnormal head positions 

Causes of nystagmus include: 

• Underdeveloped eye movement control early in life
• Albinism
• Refractive error vision problems such as nearsightedness (myopia) or astigmatism
• Congenital cataracts
• Crossed eyes (strabismus)
• Inflammation of the inner ear
• Certain medications 
  • Anti-epilepsy drugs
  • Lithium 
  • Anti-seizure medications
• Central nervous system diseases
• A family history of nystagmus
• Inner ear problems, such as Meniere’s disease
• Multiple sclerosis
• Stroke (a common cause in older people)
• Head injury/trauma (a common cause in younger people)
• Alcohol or drug use

Nystagmus is diagnosed with a patient history and a comprehensive eye exam. Testing for nystagmus may include:

• Visual acuity measurements    
• Refraction (nearsightedness, farsightedness, or astigmatism)
• Testing how the eyes focus, move and work together

Since nystagmus is often caused by other medical conditions, and additional testing to determine the underlying cause may include:

• Ear exam
• Neurological exam
• Magnetic resonance imaging (MRI) scan of the brain
• Computerized tomography (CT) scan of the brain

There is no cure for nystagmus in people who are born with the condition. Treatment for these patients may involve glasses or contact lenses which do not fix the nystagmus, but clearer vision can help slow eye movements.

Treatment for nystagmus depends on the type and may include: 

• Medications
  • Intravenous anticholinergic drugs (oral or transdermal forms are not helpful)
  • Memantine
  • Gabapentin 
  • Clonazepam
  • Isoniazid
  • Valproate
  • Baclofen 
• Botulinum toxin injections
• Prism lenses and optical solutions
• Surgery