Nystagmus, Acquired Treatment & Management

  • Author: Christopher M Bardorf, MD, MS; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Aug 18, 2009
 

Medical Care

  • Any medications that may be causing the nystagmus should be discontinued in conjunction with the patient's internist, neurologist, and/or pediatrician.
  • Significant refractive errors should be corrected. Contact lenses may be preferred over spectacles because the patient may continue to look through the optical center of the contact lens if a head turn secondary to the presence of a null zone exists. Although, this usually applies only to congenital nystagmus.
  • Base-out prisms (to induce convergence) can be used to treat downbeat nystagmus. Prisms may be useful prior to considering surgery for a face turn. Fresnel prisms directed with the base opposite the null zone (eg, for a right face turn with a null zone in left gaze, the prism over the right eye would be base out and a prism over the left eye would be base in). Null zones are more characteristic of congenital nystagmus; thus, prisms may not be applicable to most forms of acquired nystagmus.
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Surgical Care

  • Removing the inciting etiology if possible (eg, intracranial tumors, ocular media opacities)
  • Botulinum toxin may be used to treat patients with acquired nystagmus to dampen the nystagmus and to improve visual acuity and to decrease oscillopsia.
    • The toxin may be injected into the rectus muscles (2.5 U per muscle) or may be given as a retrobulbar injection[9] (10-25 U in 0.1-1 cm3).
    • Multiple injections usually are necessary as the effect of the toxin wears off.
    • Patients whose symptoms improve with botulinum toxin injection may be able to discern when the effect of the toxin begins to diminish as the symptoms may begin to recur.
    • A disadvantage of this treatment option is that botulinum toxin impairs all types of eye movement (eg, saccades, smooth pursuit).
    • Complications of toxin injection include ptosis, diplopia, and increase of nystagmus in the noninjected eye.
  • Extraocular muscle surgery for correction of nystagmus is based on surgically shifting the null zone into primary position. Again, null zones are more characteristic of congenital nystagmus; thus, they may not be applicable to most forms of acquired nystagmus. Retroequatorial rectus muscle recessions have been shown to be effective in treating acquired nystagmus without a null point.[10]
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Consultations

  • Neurologic or neuro-ophthalmic consultation should be considered.
  • Neurosurgical or oncologic consultation should be sought in cases with a neoplastic etiology.
  • Otolaryngologic consultation should be considered in cases of benign positional vertigo or other peripheral vestibular disorders.
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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.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

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.

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.

References

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