Nystagmus: Causes, Diagnosis & Treatment

Nystagmus is a condition where the eyes move or wobble in continual motion. The direction of motion may be up and down, side to side, circular, or a combination of these. 

Most people who have nystagmus have reduced vision. 

While there is no current cure for nystagmus, people with this condition often benefit from corrective eyewear, lifestyle modifications, and physical aids to improve vision.

Symptoms of Nystagmus

Rapid eye movement or wobbling can occur in one or more directions. The eyes appear to move quickly and without control. 

The types of movement are referred to in the name of each condition:

• Horizontal nystagmus (side-to-side movement)
• Vertical nystagmus (up-and-down movement)
• Rotary nystagmus (circular movement)

Movement may be slow or rapid, generally affecting both eyes. Individuals can sometimes tilt or position their heads to slow down the movement and see more clearly. 

Other symptoms of nystagmus include difficulty seeing, balance problems, dizziness, holding the head in a turned position, and tilting the head. Some people experience sensitivity to light and trouble seeing in the dark. 

Additionally, some people may experience a spinning sensation or vertigo, or images appearing to move from side to side, which is called oscillopsia. 

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Types of Nystagmus 

The two types of nystagmus are congenital and acquired.

Congenital nystagmus is a condition that appears in the first months of life. It is sometimes called infantile nystagmus syndrome (INS) or early-onset nystagmus. Children may be born with this condition or develop it within the first few months of life.

Acquired nystagmus develops later in life, any time after 6 months of age. It is often linked with another condition that affects parts of the brain, inner ear problems, or head injury.

Causes & Risk Factors

Congenital nystagmus is often linked with other medical problems. Some children who have infantile nystagmus or congenital nystagmus may also have other conditions, such as congenital cataracts, retinal dystrophies, optic nerve conditions, or aniridia. 

Other children do not have related medical problems. An inherited genetic trait may be the cause of their nystagmus.

Acquired nystagmus is often associated with other medical conditions that affect the brain. This may include stroke, brain tumors, and multiple sclerosis. Head injury may damage parts of the brain that control eye movement. 

Drug use is an additional risk factor in acquired nystagmus.

Diagnosis of Nystagmus

This condition is diagnosed by various eye tests, most often done by an ophthalmologist. 

Nystagmus may be related to other eye problems that your eye doctor will look for, including misaligned eyes (strabismus), clouded lenses (cataracts), and problems with the optic nerve.

Some eye tests use movement, such as having the patient spin around in a circle for 30 seconds and then checking for eye movement. If nystagmus is present, eyes move first in one direction and then quickly shift to the opposite.

Other tests to diagnose and confirm nystagmus include the following:

• Recordings of eye movements to confirm the type and details

• Examinations of the ear
• Neurological exams
• Brain imaging, such as a CT scan and MRI

According to the NHS, the eyes may be more stable in one direction. 

Nystagmus Treatment

Treatment for nystagmus varies depending on the exact cause. Treatment can help manage nystagmus with eyewear, vision assessment, surgery, medications, and Botox.

Eyewear

People born with nystagmus may have clearer vision with glasses or contact lenses. 

Prescriptive eyewear does not correct nystagmus itself. It corrects refractive errors, and this can help offset the vision problems associated with nystagmus. This is especially helpful in young children, as glasses can help vision to develop to the full extent possible. 

Vision Assessment

A vision specialist can help people with nystagmus make the most of the vision they have. This may include using physical tools to magnify objects, increase color contrast, or adapt to strong light. 

Surgery

Surgery is an option to lessen the impact of nystagmus for both children and adults. The goal of surgery is often to decrease head tilting, though the results vary from patient to patient.

Eye muscle surgery may be an option, which will reposition one or more eye muscles in order to lessen eye wiggling.

Medications

Some medications and drugs offer relief, particularly with acquired nystagmus. 

For example, baclofen is a muscle relaxant that is typically used to address symptoms of multiple sclerosis or spinal cord issues, and it is sometimes prescribed to people who have nystagmus. Gabapentin is also commonly used.

Drugs can sometimes help control the movements of the eyes and may reduce symptoms of wobbling. The downside can be side effects of the medications.

Botox

In some cases, Botox injections in the eye muscles may slow down eye movements. This is a temporary effect, but it may help with oscillopsia symptoms. 

Botox is associated with weakening all eye movements, however, so this approach has limited usefulness.

Additional Therapies

Therapies such as acupuncture and biofeedback aim to reduce nystagmus symptoms. Using electrical impulses or audio signals may reduce symptoms. 

According to one study, acupuncture protocols improved visual function and quality of life of nystagmus patients.

Prevention of Nystagmus

Congenital nystagmus may be due to a faulty gene. This can’t be prevented, but talk to your physician about genetic counseling if this condition runs in your family.

Acquired nystagmus can be caused due to brain damage in areas responsible for eye movements. Prevention efforts may include lifestyle modifications to prevent stroke. 

Excessive alcohol and drug use may also be a contributing factor. Prevention efforts include stopping excessive use of alcohol or drugs. 

Tips for Living With Nystagmus

If you have nystagmus, there are certain things you can do to make it easier to live with it.

Get an Early Diagnosis 

The sooner you or your child get assistance from a qualified teacher or health care provider, the better the long-term outcome on visual function. A skilled professional can offer tips to enhance education, learning, play, and development.

Get Support

If you or your child has a visual impairment, you may be able to get support from infancy to higher education.  

Investigate social services, as you may be eligible when there is partial or full vision impairment. This can help you gain access to services, expert guidance, and financial aid in some cases.

Use Physical Aids for Ease in Daily Life

Some adjustments can make things easier to see in daily life. Use better lighting, so it’s easier to see when you’re reading, writing, or doing up-close work. 

Consider adding “bumpons” to things in your home. These are raised adhesives that mark buttons on appliances such as the “on” setting on a dishwasher or washing machine. 

Explore ways to see colors better with a color and light detector, so you can identify up to 150 colors with ease. Use magnifiers to read easily, see the fine print, and do fine handicrafts. 

Find the Best Position

Children often have a place where they can see best, called the null point. This is the placement where it’s easier for them to see. Encourage them to position themselves in this posture and make the most of their comfort zone.

Hold Things Close

Some children will have the urge to hold things closely, and this is a placement where the nystagmus wobbling is least. Encourage this behavior as it makes them feel comfortable. 

Take Things Slow & Take Breaks

Some children may need longer to read or complete certain activities. Encourage them to take their time and take breaks as needed. 

Talk With an Expert Vision Specialist

A specialist or vision teacher can give you extra tips and support. They may offer practical hands-on suggestions to ease play, learning, and development. 

Nystagmus FAQs

What causes nystagmus?

For some individuals, there is no apparent cause. In other cases, nystagmus may be related to eye problems such as cataracts, strabismus, and focusing problems. 

Additional causes of nystagmus include the following: 

• Family history of nystagmus
• Multiple sclerosis
• Stroke or brain injury
• Head injury
• Use of anti-seizure medications such as lithium
• Alcohol or drug use

For acquired nystagmus, stroke is a common cause in older adults, and head injury is a common cause in younger people.

Can nystagmus be corrected?

People born with this condition cannot be cured, but they may benefit from corrective eyewear or surgery. 

Acquired nystagmus sometimes goes away if the cause of the condition is treated, such as stopping drug or alcohol use.

What does someone with nystagmus see?

Children with nystagmus may have blurry vision, but they don’t see things as shaking. Adults report that they see things looking shaky.

What is the best treatment for nystagmus?

Medications like baclofen and gabapentin are generally the most used treatment for periodic nystagmus. Surgery is also an option.

Is there a cure for nystagmus?

There is no cure, but symptoms can be treated with medications, injections, corrective lenses, and surgery.

References

1. What Is Nystagmus?  American Academy of Ophthalmology.

2. Nystagmus. EyeWiki, American Academy of Ophthalmology.

3. Nystagmus. American Association for Pediatric Ophthalmology and Strabismus.

4. Nystagmus. (February 2021). JAMA Ophthalmology.

5. Nystagmus: Definition, Causes & Treatment. Cleveland Clinic.

6. Infantile Nystagmus. American Academy of Ophthalmology (AAO).

7. The Genetics of Aniridia — Simple Things Become Complicated. (February 2018). Journal of Applied Genetics.

8. Making Sense of Acquired Adult Nystagmus. American Academy of Ophthalmology.

9. Nystagmus. Great Ormond Street Hospital for Children, National Health Service.

10. Surgical Treatment of Nystagmus: on Whom, When, and How to Operate? (November 2017). American Academy of Ophthalmology.

11. Clinical and Electrophysiological Results of Eye Muscle Surgery in 17 Patients With Downbeat Nystagmus. (January 2019). Indian Journal of Ophthalmology.

12. Eye Muscle Surgery for Infantile Nystagmus Syndrome in the First Two Years of Life. (November 2009). Clinical Ophthalmology.