Imaging Studies

Any patient who develops nystagmus without an identifiable cause (eg, Ménière disease, drug toxicity) or with localizing neurologic deficits should undergo neuroimaging. A complete history and neuro-ophthalmic examination are crucial to localizing an intracranial disorder. Communication with the neuroradiologist regarding such localization is important in ensuring that regions of the brain suggestive of a disorder are imaged adequately.

Central vestibular forms of nystagmus are always pathologic and deserve a thorough evaluation. MRI is the preferred method of neuroimaging.

Infantile nystagmus typically manifests in the first six months of life, and the oscillations are usually pendular rather than jerk. Visual loss, if present, is stable and not progressive. Any child who develops nystagmus in early childhood should be evaluated carefully. The presence of a pale optic disk a history of progressive visual loss or unilateral vertical nystagmus should suggest that the nystagmus is acquired and possibly due to a neoplasm involving the visual system. Such patients require neuroimaging with MRI.

Optic chiasm or third ventricle gliomas can cause a condition that mimics spasmus nutans. All children with spasmus nutans should undergo a complete neuro-ophthalmic examination. Signs suggestive of a neoplastic etiology include decreased visual acuity, relative afferent pupillary defect, optic disc pallor, failure to thrive, age of onset before 12 months, and vertical or seesaw nystagmus. All such children should undergo an MRI. If the decision is made to delay MRI in children without neurologic deficit, they should be observed closely for onset of such neurologic deficits.

Other Tests

Electronystagmographs record eye muscle contractions to evaluate the direction and velocity of nystagmus. It may be used to evaluate low-amplitude nystagmus that is difficult to discern on examination. This study can help determine the type and velocity of the nystagmus, which is important in directing therapy.

Treatment & Management

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Author

Christopher M Bardorf, MD, MS Ophthalmologist, Children's Eye Physicians

Christopher M Bardorf, MD, MS is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Gregory Van Stavern, MD Attending Physician, Department of Ophthalmology and Neurology, Washington University School of Medicine

Gregory Van Stavern, MD is a member of the following medical societies: American Academy of Neurology, 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, Association for Research in Vision and Ophthalmology, American Society of Retina Specialists, Retina Society, Society for Neuroscience

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Edsel B Ing, MD, MPH, FRCSC Professor, Department of Ophthalmology and Vision Sciences, University of Toronto Faculty of Medicine; Active Staff, Michael Garron Hospital (Toronto East Health Network)

Edsel B Ing, MD, MPH, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Society of Ophthalmic Plastic and Reconstructive Surgery, Canadian Medical Association, Canadian Ophthalmological Society, Canadian Society of Oculoplastic Surgery, Chinese Canadian Medical Society, European Society of Ophthalmic Plastic and Reconstructive Surgery, North American Neuro-Ophthalmology Society, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada, Statistical Society of Canada

Disclosure: Nothing to disclose.

Additional Contributors

Michael J Bartiss, OD, MD Medical Director, Ophthalmology, Family Eye Care of the Carolinas and Surgery Center of Pinehurst

Michael J Bartiss, OD, MD is a member of the following medical societies: American Academy of Ophthalmology, North Carolina Medical Society, American Academy of Pediatrics, American Association for Pediatric Ophthalmology and Strabismus

Disclosure: Nothing to disclose.

Acknowledgements

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.

Sections Acquired Nystagmus
Overview
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DDx
Workup
Treatment
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Acquired Nystagmus Workup

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