eMedicine Specialties > Ophthalmology > Extraocular Muscles

Nystagmus, Acquired: Follow-up

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

Follow-up

Further Outpatient Care

  • Regular office visits are useful to monitor nystagmus.

Prognosis

  • Prognosis is dependent upon etiology.

Miscellaneous

Medicolegal Pitfalls

  • The principal medical/legal pitfall in the management of acquired nystagmus is related to misdiagnosis of a serious or life-threatening etiology. Life-threatening causes of nystagmus should first be ruled out with a pertinent history and physical examination. Appropriate consultation and/or imaging should be obtained without delay if a serious underlying cause is suspected.

Special Concerns

  • Bruns nystagmus
    • The first manifestation of slow-growing cerebello-pontine angle tumors (eg, acoustic neurinoma, exophytic brain stem glioma, cerebellar tumors, metastases) may be a vestibular nystagmus associated with peripheral vestibular symptoms. Peripheral vestibular nystagmus has a horizontal jerk component with the fast phase directed away from the side of the lesion. In addition, an ipsilateral, slow, gaze-evoked nystagmus with gaze to the side of the lesion may be seen as the tumor expands to compress the brain stem. A small amplitude rapid jerk nystagmus in primary position with the fast phase directed away from the side of the lesion in combination with a slow, gaze-evoked nystagmus directed toward the side of the lesion suggests a mass compressing the brain stem with peripheral vestibular nerve involvement. This is known as Bruns nystagmus.
    • Acquired nystagmus most often is a result of vestibular dysfunction. A resting tone is present in the vestibular system, even when the head is at rest. Therefore, any loss of neural activity on either side from a pathologic process (eg, mass lesion, ischemia) results in a relative overexcitation of the contralateral side, causing the eyes to drift toward the side of the lesion (ie, nystagmus with the fast phase away from the lesion).
 


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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