eMedicine Specialties > Ophthalmology > Extraocular Muscles

Nystagmus, Acquired: Differential Diagnoses & Workup

Author: Christopher M Bardorf, MD, MS, Ophthalmology, Children's Eye Physicians, Denver, CO
Coauthor(s): Gregory P Van Stavern, MD, FACP, Assistant Professor, Departments of Ophthalmology and Neurology, Wayne State University; Enrique Garcia-Valenzuela, MD, PhD, Clinical Assistant Professor, Department of Ophthalmology, University of Illinois Eye and Ear Infirmary; Consulting Staff, Vitreo-Retinal Surgery, Midwest Retina Consultants, SC, Parkside Center
Contributor Information and Disclosures

Updated: Aug 18, 2009

Differential Diagnoses

Nystagmus, Congenital

Other Problems to Be Considered

Ocular flutter
Ocular bobbing
Opsoclonus
Repetitive square wave jerks
Macrosaccadic oscillations
Superior oblique myokymia

Workup

Imaging Studies

  • Any patient who develops nystagmus without an identifiable cause (eg, Ménière disease, drug toxicity) or with localizing neurologic deficits should undergo neuroimaging. A complete history and neuro-ophthalmic examination are crucial to localizing an intracranial disorder. Communication with the neuroradiologist regarding such localization is important in ensuring that regions of the brain suggestive of a disorder are imaged adequately.
  • Central vestibular forms of nystagmus are always pathologic and deserve a thorough evaluation. MRI is the preferred method of neuroimaging.
  • Congenital forms of nystagmus typically appear at birth or during infancy and usually are pendular rather than jerk. Visual loss, if present, is stable and not progressive. Any child who develops nystagmus in early childhood should be evaluated carefully. The presence of a pale optic disk, or a history of progressive visual loss, should suggest that the nystagmus is acquired and possibly due to a neoplasm involving the visual system. Such patients require neuroimaging with MRI.
  • Optic chiasm or third ventricle gliomas can cause a condition that mimics spasmus nutans. All children with spasmus nutans should undergo a complete neuro-ophthalmic examination. Signs suggestive of a neoplastic etiology include decreased visual acuity, afferent pupillary defect, optic disc pallor, failure to thrive, age of onset before 12 months, and vertical or seesaw nystagmus. All such children should undergo an MRI. If the decision is made to delay MRI in children without neurologic deficit, they should be observed closely for onset of such neurologic deficits.

Other Tests

  • Electronystagmographs record eye muscle contractions to evaluate the direction and velocity of nystagmus. It may be used to evaluate low-amplitude nystagmus that is difficult to discern on examination. This study can help determine the type and velocity of the nystagmus, which is important in directing therapy.

More on Nystagmus, Acquired

Overview: Nystagmus, Acquired
Differential Diagnoses & Workup: Nystagmus, Acquired
Treatment & Medication: Nystagmus, Acquired
Follow-up: Nystagmus, Acquired
References
Further Reading
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References

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Keywords

acquired nystagmus, downbeat nystagmus, upbeat nystagmus, periodic alternating nystagmus, horizontal nystagmus, vertical nystagmus, optokinetic nystagmus, rotary nystagmus, vestibular nystagmus, oscillopsia, congenital nystagmus, spasmus nutans

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Contributor Information and Disclosures

Author

Christopher M Bardorf, MD, MS, Ophthalmology, Children's Eye Physicians, Denver, CO
Christopher M Bardorf, MD, MS is a member of the following medical societies: American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Gregory P Van Stavern, MD, FACP, Assistant Professor, Departments of Ophthalmology and Neurology, Wayne State University
Gregory P Van Stavern, MD, FACP is a member of the following medical societies: American Academy of Neurology and North American Neuro-Ophthalmology Society
Disclosure: Nothing to disclose.

Enrique Garcia-Valenzuela, MD, PhD, Clinical Assistant Professor, Department of Ophthalmology, University of Illinois Eye and Ear Infirmary; Consulting Staff, Vitreo-Retinal Surgery, Midwest Retina Consultants, SC, Parkside Center
Enrique Garcia-Valenzuela, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Retina Society, and Society for Neuroscience
Disclosure: Nothing to disclose.

Medical Editor

Michael J Bartiss, OD, MD, Medical Director, Ophthalmology, Family Eye Care of the Carolinas
Michael J Bartiss, OD, MD is a member of the following medical societies: American Academy of Ophthalmology, American Academy of Pediatrics, American Association for Pediatric Ophthalmology and Strabismus, and North Carolina Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Brian R Younge, MD, Professor of Ophthalmology, Mayo Clinic School of Medicine
Brian R Younge, MD is a member of the following medical societies: American Medical Association, American Ophthalmological Society, and North American Neuro-Ophthalmology Society
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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