Nystagmus, Acquired Treatment & Management
- Author: Christopher M Bardorf, MD, MS; Chief Editor: Hampton Roy Sr, MD more...
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.
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]
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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