NYSTAGMUS

 Is an abnormal involuntary eye movement

 Which is secondary to

- Inability to maintain fixation

- Loss of normal inhibitory influence on eye movement
. It has two phases
- A slow drift from the target of interest
- A corrective saccade from back to the target of interest
. A difference in the speed of the two phases causes Jerk
nystagmus, and when the back and forth movements are equal
in both speed and amplitude it causes pendular nystagmus.
. By convention the direction of Jerk nystagmus is reported as the
direction of fast phase phenomenon
 When the size of oscillation differs in each eye it is
called dissociated nystagmus.
 When the direction of oscillation differs it is called
disconjugate or disjunctive nystagmus.
 The amplitude of nystagmus often changes with
gaze position , a few beats of nystagmus are
normally present in extremes of horizontal gaze
(beyond 45 degree) especially in older patients this
shouldn't be considered abnormal unless the
nystagmus is persistent.
CONGENITAL NYSTAGMUS

. It could be jerk or pendular

. Manifests with in the first few months of life
 Positive family history

 Almost always conjugate and horizontal

 Patients are not bothered by the eye movement.

 Vision may be good or poor.

 Nystagmus may be continuous or intermittent

 There is a null point

 If the null point is not in the primary position patient often

adopts a head tilt to improve vision

 Visual fixation on a distant target usually amplifies conjugate

nystagmus but convergence on a near target damps it.

 15% of patients have strabismus
 No osilopsia
 Abolishes in sleep

LATENT NYSTAGMUS
. Conjugate jerk nystagmus
. Begins when binocular fusion is disrupted
. Fast phase beat towards the viewing eye
. Esotropia almost always present
. Esotropic eye usually has decreased visual acuity
 Subnormal steriopsis
 Variably presents as the esotropic eye is supressed
 May be present with congenital nystagmus in the
same patient

MONOCULAR NYSTAGMUS OF CHILDHOOD

. Nystagmus only in one eye
. Vertical
. Smaller amplitude
. The eye with nystagmus may have reduced visual
acuity, Optic atrophy, RAPD
TREATMENT OF NYSTAGMUS
 1. GABA agonist e.g Baclofen, clonazepam,
Gabapentin.
 2.Nystagmus associated with amblyiopia can be
improved with amblyiopia therapy.
 3. Base out prism can be given to those patients
whose nystagmus decreases with convergence.
 4. Surgery—Anderson-Kestonbaum procedure to
bring the null point to primary position.