Nystagmus, Congenital Medication

  • Author: Theodore Curtis, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Jan 26, 2010
 

Medication Summary

The only drugs used in the management of nystagmus are not useful in infants but are useful in adults with persistent nystagmus in which the motility disturbance itself is believed to cause visual impairment or other undesirable symptoms.

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Anticonvulsants

Class Summary

Agents acting through gabapentin binding sites that may activate voltage-gated calcium channels may be useful in treating nystagmus.

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Gabapentin (Neurontin)

 

Has been shown to be useful in some adults with congenital nystagmus in improving symptoms. No studies have been done in children to date. Exact mechanism of action is unknown but thought to be due to its antiglutamatergic activity. Has been used successfully to treat adult acquired nystagmus in multiple sclerosis.

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Skeletal muscle relaxants

Class Summary

Agents used to treat reversible or intractable spasticity are helpful.

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Baclofen (Lioresal)

 

May be effective in reducing nystagmus in adult patients with a history of idiopathic infantile nystagmus. Exact therapeutic mechanism unknown but may relate to inhibition of glutamate release rather than augmentation of GABA-ergic pathways as originally believed. It has been used to treat several types of nystagmus, most commonly PAN.

Improvements in nystagmus intensity appear within minutes and regress after several hours. Medication should not be taken at bedtime or other times when use of eyes is not anticipated.

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Neuromuscular Blocking Agents, Toxin

Class Summary

Agents that produce a state of muscle denervation are helpful.

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OnabotulinumtoxinA (BOTOX®)

 

Used in treatment of nystagmus by injection into specific extraocular muscles and retrobulbar placement within the muscle cone.

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Contributor Information and Disclosures
Author

Theodore Curtis, MD  Assistant Professor, Department of Ophthalmology, University of Colorado; Consulting Staff, Rocky Mountain Lions Eye Institute

Theodore Curtis, MD is a member of the following medical societies: American Academy of Ophthalmology and American Association for Pediatric Ophthalmology and Strabismus

Disclosure: Nothing to disclose.

Coauthor(s)

David T Wheeler, MD  Associate Professor, Departments of Ophthalmology and Pediatrics, Oregon Health & Science University

David T Wheeler, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, and Phi Beta Kappa

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.

Simon K Law, MD, PharmD  Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

J James Rowsey, MD  Former Director of Corneal Services, St Luke's Cataract and Laser Institute, Florida

J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Pan-American Association of Ophthalmology, Sigma Xi, and Southern Medical Association

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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  13. Miura K, Hertle RW, FitzGibbon EJ. Effects of tenotomy surgery on congenital nystagmus waveforms in adult patients. Part II. Dynamical systems analysis. Vision Res. Oct 2003;43(22):2357-62. [Medline].

  14. Pratt-Johnson JA. Results of surgery to modify the null-zone position in congenital nystagmus. Can J Ophthalmol. Jun 1991;26(4):219-23. [Medline].

  15. Reinecke RD. Costenbader Lecture. Idiopathic infantile nystagmus: diagnosis and treatment. J AAPOS. Jun 1997;1(2):67-82. [Medline].

  16. Sarvananthan N, Proudlock FA, Choudhuri I. Pharmacologic treatment of congenital nystagmus. Arch Ophthalmol. 2006;124:916-8. [Medline].

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