Acquired Nystagmus Treatment & Management

Updated: Oct 17, 2018
  • Author: Christopher M Bardorf, MD, MS; Chief Editor: Edsel Ing, MD, MPH, FRCSC  more...
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Treatment

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. [15]

Base-out prisms (eg,7 diopters) with a -1.00 myopic correction may be used for convergence damping in infantile nystagmus. Base-out prisms (to induce convergence) have also been described to treat downbeat nystagmus with a pseudocycloid waveform. [16] 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. [15]

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Surgical Care

See the list below:

  • 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 [17] (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, increase of nystagmus in the noninjected eye, and, rarely, globe rupture.

  • 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, [18] as has extraocular muscle tenotomies with reattachment. [19]

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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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