Nystagmus is an eye condition that causes involuntary, repetitive eye movements. Imagine your eyes dancing to a rhythm you can’t control – that’s what nystagmus feels like. These movements may occur horizontally, vertically, or in a circular pattern, leading to difficulties in maintaining a steady gaze on objects. For many individuals and their families, nystagmus can severely impact daily life, causing struggles with vision, balance, and coordination. It’s essential to understand that nystagmus is not simply a visual problem; it can be indicative of underlying neurological or ocular conditions, making diagnosis and treatment crucial.

There are two categories of Nystagmus, congenital or infantile nystagmus refers to nystagmus that occurs at or shortly after birth, and acquired nystagmus, referring to nystagmus that is acquired after the age of 6 months. 

 Understanding the Causes of Congenital Nystagmus

There are many causes of congenital nystagmus, with some of the more common causes being: 

• Albinism 
• Leber Congenital Amaurosis(LCA) and other Non-LCA retinal dystrophies
• Optic nerve abnormalities
• In about 9% of cases, no specific cause can be identified. 

Genetic and Hereditary Conditions

Genetic factors are a leading cause of congenital nystagmus, often disrupting eye or visual system development.

• Albinism: Reduced melanin affecting the eyes (ocular albinism) or skin and eyes (oculocutaneous albinism).
• FRMD7 gene mutations: A major hereditary cause of nystagmus.
• Retinal dystrophies: Inherited disorders affecting retinal function.
• Achromatopsia: Genetic cone dysfunction leading to reduced vision.
• Congenital stationary night blindness (CSNB): Night vision impairment, often with nystagmus.

Eye Development Abnormalities

Structural issues in the eyes, present from birth, can interfere with normal vision and trigger nystagmus.

• Foveal hypoplasia: Underdeveloped retina center critical for sharp vision.
• Congenital cataracts: Lens clouding at birth that disrupts clear vision.
• Aniridia: Absence or partial absence of the iris (colored part of the eye).

Optic Nerve Disorders

Optic nerve abnormalities impair the transmission of visual information from the eyes to the brain.

• Optic nerve hypoplasia (ONH): Underdeveloped optic nerves, a common cause of visual impairment in infants.
• Optic atrophy: Degeneration or damage to the optic nerves.

Retinal and Vision System Disorders

Disorders that affect the retina or visual processing pathways can lead to early-onset nystagmus.

• Inherited retinal dystrophies such as Leber congenital amaurosis (LCA), Rod-cone dystrophy, and Alstrom syndrome.

Neurological and Brain-Related Causes

Abnormalities in the brain or central nervous system can impact eye movement control.

• Hydrocephalus: Fluid buildup in the brain affecting visual pathways.
• Achiasma: Failure of optic nerve fibers to cross at the optic chiasm, causing significant visual impairment.
• Joubert syndrome: Genetic brain malformation often presenting with nystagmus and developmental delays.

Metabolic and Systemic Disorders

Certain systemic or metabolic conditions can result in nystagmus, typically alongside other symptoms.

• Cobalamin (B12) deficiencies: Affects retinal function and vision.
• Zellweger syndrome: A severe peroxisomal disorder with retinal degeneration.
• Pelizaeus-Merzbacher disease: A hypomyelination disorder affecting motor function and vision.

Vestibular and Balance Disorders

Impaired balance systems can lead to nystagmus linked to head and eye movement.

• Vestibular apparatus disorders: Dysfunction of the semicircular canals and otolithic organs.
• Congenital infections: Cytomegalovirus (CMV) or bacterial meningitis affecting the inner ear.

Understanding the Causes of Acquired Nystagmus

This type appears later in life, sometimes even in adulthood. It often results from other health issues or outside factors.

Common causes include:

• Brain related conditions such as multiple sclerosis
• Head injuries
• Side effects from certain medicines
• Excessive alcohol or drug use
• Stroke

Neurological and Central Nervous System (CNS) Disorders

These are among the most common causes of acquired nystagmus, involving damage to the brain or spinal cord.

• Multiple sclerosis (MS)
• Stroke
• Trauma or head injury
• Brain tumors (e.g., medulloblastoma, astrocytoma)
• Cerebellar disorders (e.g., ataxia, abscess)
• Chiari malformation
• Thalamic hemorrhage

Medications

Certain prescription and over-the-counter drugs can cause nystagmus as a side effect, particularly when taken in high doses or in cases of toxicity.

• Anticonvulsants and Sedatives:
  • Phenytoin (Dilantin)
  • Benzodiazepines
  • Barbiturates
  • Pregabalin
  • Other anticonvulsants
• Psychotropic Drugs:
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Lithium
• Anesthetics and Dissociative Agents:
  • Ketamine
  • Nitrous oxide
• Other Medications:
  • Salicylates (e.g., aspirin at toxic levels)

Vestibular and Balance Disorders

Disruptions in the inner ear or vestibular system often lead to nystagmus, typically accompanied by dizziness or vertigo.

• Benign paroxysmal positional vertigo (BPPV)
• Ménière’s disease
• Vestibular neuritis
• Superior canal dehiscence syndrome (SCDS)
• Tullio phenomenon

Recreational Drugs

Illicit or recreational drug use can lead to nystagmus, particularly when these substances affect the central nervous system.

• Alcohol intoxication
• Amphetamines
• MDMA (ecstasy)
• Phencyclidine (PCP)
• Dextromethorphan (in high doses, often as part of recreational misuse)

Eye Problems

• Severe near or farsightedness
• Eyes that don’t line up properly (like a lazy eye)
• Diseases affecting the retina (the light-sensitive part of the eye)

General Diseases and Conditions

Certain systemic or inherited diseases may present with nystagmus as a symptom.

• Aniridia
• Optic nerve hypoplasia
• Canavan disease
• Pelizaeus-Merzbacher disease
• Whipple’s disease
• Thiamine deficiency (e.g., Wernicke’s encephalopathy, Korsakoff syndrome)

Trusted Nystagmus Specialists in Orange County

At Insight Vision Center Optometry, Dr. Valerie Lam and Dr. Ariel Chen lead our team in providing expert care for children with nystagmus and other vision conditions. With advanced training in developmental vision, we offer comprehensive services tailored to improving visual stability and functionality, including pediatric eye exams, vision therapy, and customized treatment plans. Families across Orange County rely on our compassionate care, experienced doctors, state-of-the-art technology, and welcoming environment to support their child’s vision needs.

How Do the Eyes Move in Nystagmus?

The way eyes move in nystagmus can vary:

Side-to-Side: Horizontal Nystagmus

This is the most common type. Eyes move left to right and back again, like watching a tennis match in fast-forward.

Up-and-Down: Vertical Nystagmus

Less common, this type involves eyes moving up and down. It’s often a sign of a problem in the brain.

Circular: Rotary Nystagmus

In this rare form, eyes move in a circular pattern, like tracing the edge of a coin.

Special Types of Nystagmus

Some forms of nystagmus have unique features:

• Pendular Nystagmus: Eyes move back and forth at the same speed, like a pendulum on a clock.
• Jerk Nystagmus: Eyes drift slowly in one direction, then quickly “jerk” back. It’s like when you’re trying to read in a moving car – your eyes drift along with the movement, then quickly snap back to where you were reading.
• Spasmus Nutans: This rare type affects infants. Along with eye movements, babies might nod their heads or tilt them to one side. Thankfully, it often goes away on its own.

When is Nystagmus Normal?

Sometimes, nystagmus is just your eyes working normally for healthy people under certain conditions:

• When you look at moving stripes or a spinning pattern (like watching scenery from a moving train)
• After spinning around (like after a merry-go-round ride)

Identifying Symptoms of Nystagmus

Involuntary Eye Movements

Nystagmus is characterized by involuntary eye movements that can manifest in various patterns, including rhythmic oscillations moving side to side, up and down, or in a circular motion. These movements may occur in one or both eyes, making steady focus on objects difficult. As a result, individuals may experience blurriness and shakiness in their vision, which can understandably be frustrating and disorienting for both adults and children alike. Parents often notice unusual head positions or nodding motions in their children as they attempt to compensate for this condition.

Impact on Vision and Depth Perception

The effects of nystagmus extend beyond involuntary eye movements; they significantly impair vision and depth perception. Individuals may struggle to gauge distances accurately, which can pose risks while driving or engaging in sports. Reports estimate that 1 in 1,000 individuals may be affected by this condition, making it a leading cause of visual impairment in school-aged children. For parents observing their child’s daily struggles with basic visual tasks, such as reading or playing sports, these challenges can be heart-wrenching.

• Involuntary eye movements lead to difficulty maintaining a clear view.
• Depth perception issues can affect day-to-day activities, leading to frustration.
• Children may face challenges in academic performance or sports participation.

Associated Balance and Coordination Issues

Nystagmus can also contribute to balance and coordination difficulties. As the eyes struggle to maintain stable images, affected individuals may experience dizziness or unsteadiness, impacting their ability to navigate daily activities with confidence. This can lead to an increased risk of falls, particularly in children who are still developing their motor skills. For parents, witnessing their child’s struggles with coordination can be distressing, and often prompts concerns about their safety and overall well-being.

• Difficulty in maintaining balance can lead to increased fall risks.
• Children may display awkward movements or difficulties in sports.
• Unsteady gait can cause anxiety for both patients and their families.

Insight Vision Center Optometry in Costa Mesa is a trusted pediatric vision clinic, with families referred to us from all over Orange County, including nearby cities like Irvine, Huntington Beach, and Santa Ana.

Diagnosing Nystagmus

Functional Eye Examination

Diagnosing nystagmus begins with an in depth eye examination that looks at a wide range of visual processes and how the eyes perform in dynamic situations (as opposed to just looking at something from 20 feet away. During the exam, the eye doctor will carefully assess how the eyes move, work together, and focus.

Treatment Options for Nystagmus

Vision Therapy and Its Benefits

For many individuals suffering from nystagmus, vision therapy or neuro optometric rehabilitation can be a game-changer. This specialized treatment focuses on enhancing visual skills and functions through structured exercises. A multi-sensory approach is employed, engaging visual, auditory, and tactile feedback to promote effective eye movement and coordination.

• Improved Visual Skills: Vision therapy is designed to train and enhance crucial visual skills such as eye control, coordination, and tracking. These improvements can benefit both children and adults, facilitating better eye contact and focus during social interactions.
• Sustained Focus: Patients may find significant improvement in their ability to maintain focus, especially during tasks that require prolonged visual concentration, like reading or computer work.
• Positive Cosmetic Impact: In some cases, vision therapy can also address cosmetic aspects of nystagmus, which can boost self-esteem and social engagement for children and adults alike.
• Temporary Reduction of Symptoms: Research indicates that some patients can temporarily reduce the severity of their nystagmus symptoms for specific periods after therapy. This is particularly beneficial during important social events or business meetings.

Critical Exercises for Improvement

Vision therapy comprises various exercises targeting specific visual skills essential for effective functioning. These exercises include:

• Eye Tracking Exercises: Designed to improve the ability to follow moving objects smoothly.
• Fixation Exercises: Focus on maintaining a steady gaze on stationary objects for longer durations.
• Visual-Motor Integration Activities: These exercises help in coordinating eye movements with body movements, enhancing motor skills.
• Eye Control and Convergence Training: Aiding in maintaining eye contact during conversations and activities, which is crucial for social engagement.
• Visual Perception Training: Enhancing the ability to interpret visual information effectively, vital for reading and comprehension tasks.

Use of Corrective Lenses and Other Devices

While corrective lenses—including glasses and contact lenses—do not directly treat nystagmus, specialized lenses called prism lenses may be used to treat nystagmus. Individuals may also benefit from specialized glasses designed to expand the “null zone,” the gaze position where nystagmus is minimized. While the effectiveness of these devices varies from person to person, they can provide practical relief.

Surgical Interventions and Limitations

In certain severe cases where nystagmus significantly impacts daily life, surgical options may be explored. Surgical procedures can involve repositioning the eye muscles to help reduce unwanted movements. However, it is essential to note that surgery does not cure nystagmus; rather, it aims to make vision more manageable by decreasing head turns and improving visual function.

It’s important to approach surgical interventions with realistic expectations, as outcomes can vary widely and may include potential side effects such as double vision or visual fatigue. Thus, a thorough discussion with an optometrist or ophthalmologist about the risks and benefits is crucial.

Role of a Neuro Optometrist or Developmental Optometrist in Managing Nystagmus

A neuro optometrist or developmental optometrist plays a crucial role in the evaluation and management of nystagmus through vision therapy. These specialists possess the necessary expertise to assess how visual deficits intertwine with neurological function, shaping a tailored treatment plan that caters to individual needs.

In addition to diagnoses, and recommended treatment, they serve an important role in collaborating with other healthcare professionals, ensuring that underlying health issues are addressed, particularly if nystagmus is a symptom of another medical condition.

Compassionate Nystagmus Care and Vision Therapy in Orange County

Insight Vision Center Optometry in Costa Mesa is committed to offering specialized care for children with nystagmus and other vision challenges across Orange County. Dr. Lam and Dr. Chen excel in diagnosing and managing nystagmus to improve visual stability and support your child’s daily life and developmental needs. Families from Irvine, Huntington Beach, and Santa Ana trust our practice for personalized and attentive care tailored to each young patient. Call us at (714) 942-1361 to schedule your child’s appointment, or book online.