Nystagmus Test: Purpose and Procedure

What is Nystagmus?

Nystagmus is a vision condition resulting in repetitive, uncontrolled movement of the eyes. It can affect vision and depth perception, making reading and concentrating difficult.

Eye movements can follow a pattern of side-to-side, up-and-down, or circular motions, making it hard to focus on objects. As a result, people may tilt their head, nod, or cover one eye to compensate for their vision impairment.

Nystagmus affects about 0.17% of the population under 18.¹ Testing for nystagmus is done by an ophthalmologist through a comprehensive eye exam.

What are the Different Types of Nystagmus?

The two main types of nystagmus are early onset (congenital) and acquired.

Congenital nystagmus (infantile nystagmus) is characterized by slow and rapid side-to-side eye movements.¹ It typically develops three months after birth and can be spontaneous or inherited, affecting about 0.14% of the general population. 

Acquired nystagmus develops later in life and is often associated with problems with the central nervous system, metabolic disorders, or drug and alcohol toxicity.

What are the Signs and Symptoms of Nystagmus?

The main symptom of nystagmus is involuntary or rapid eye movements in one or both eyes. 

Other symptoms may include:

• Vertigo
• Dizziness
• Blurry vision 
• Nighttime vision problems
• Trouble with balance and coordination

How Does Nystagmus Affect Vision?

The rapid eye movements of nystagmus can cause vision problems because of the inability to hold a steady gaze on an object. 

Vision problems might include:

• Blurry vision
• Jumpy/shaky vision 
• Inability to focus
• Trouble seeing at night 
• Reduced depth perception 

How is Nystagmus Diagnosed?

Healthcare professionals start the diagnosis process with a comprehensive eye exam, detailed medical history, and physical assessment. Since various factors can cause nystagmus, diagnosing the condition can be tricky. 

Other tests and observations associated with a nystagmus diagnosis may include:

• Visual acuity (distance vision) screening
• Slit-lamp examination to look for structural abnormalities
• Assess the direction and stability of eye movement
• Assess the eye’s ability to focus on an object
• Look for conjugacy (both eyes moving together)
• Analyze the speed of eye movements (slow or rapid, continuous or intermittent)
• Inner ear exam
• Brain MRI
• Neurological assessment

An eye doctor or other medical professionals may refer you to a primary care physician if an underlying medical condition is suspected. The goal is to determine the root cause and how it affects vision and quality of life.

When Should One Seek Medical Advice for Nystagmus?

You should immediately seek medical attention if nystagmus develops spontaneously, especially following a head injury. Nystagmus, alongside vertigo, dizziness, and balance issues, could point to a problem with the inner ear and should be evaluated by a doctor as soon as possible.

What Causes Nystagmus?

Congenital nystagmus is usually caused by congenital cataracts or lack of normal eye development after birth.

Acquired nystagmus that develops spontaneously or later in life is often caused by an underlying medical condition such as:

• Stroke
• Multiple sclerosis
• High refractive error (myopia, astigmatism)
• Inner ear inflammation
• Anti-epileptic medication 
• Head injury
• Albinism (light skin, hair, and eyes)
• Drug use (MDMA, PCP, LSD)
• Central nervous system disorders

How Can Head Injuries Lead to Nystagmus?

Nystagmus after a traumatic head injury or concussion can develop if the vestibular system or brainstem is affected. The vestibular system is found in the inner ear and helps control eye movements and balance.

After a head injury, healthcare professionals should assess visual eye movement and look for nystagmus symptoms to rule out damage to some brain regions. 

How is Nystagmus Treated and Managed?

The first step in treating nystagmus is to find and treat the underlying cause of the rapid eye movement. The next step is to improve vision and other symptoms affecting daily life.

What are the Available Treatment Options?

While there is no cure for infantile nystagmus, there are several treatment options available to improve vision, including:

• Correct refractive errors with glasses or contact lenses
• Prisms can help correct head tilt or positioning
• Surgical intervention to recess eye muscles
• Medication (gabapentin, baclofen, memantine)
• Botulinum toxin injection into the retrobulbar space

Can Lifestyle Adjustments Aid in Managing Nystagmus?

While medical treatment options may not remove nystagmus symptoms entirely, there are ways to help manage nystagmus in your daily life.

These supports include:

• Using large print books
• Increase the font size on your computer and phone
• Use of a magnifying glass while reading
• Increase light
• Support groups to help with confidence and self-esteem
• Reduce clutter in your work and living environment

Are There Preventive Measures for Nystagmus?

People with nystagmus may notice specific triggers, such as stress, fatigue, or illness, that can exacerbate their symptoms. 

Finding ways to help minimize symptoms can help you manage your day-to-day symptoms. 

These measures might include:

• Finding ways to reduce stress (yoga, mindfulness)
• Getting enough sleep
• Rest if you are sick
• Playing physical games and exercises  that require eye/hand coordination 
• Position a child in a classroom that is comfortable for them
• Create a quiet environment to be able to rest your eyes if they are fatigued
• Organize living space so depth perception issues are not a safety hazard (stairs, flooring, etc.)

Summary

Nystagmus is an eye condition that results in uncontrollable rapid and slow eye movements that can affect vision and quality of life. It can develop early in a child’s life or later into adulthood, which may indicate an underlying medical condition. 

Treatment, including medication, eyeglasses, vision training, or surgery, focuses on improving vision and reducing symptoms to enhance daily life. Reducing stress, improving sleep, and having a quiet resting place are other ways to help manage nystagmus symptoms.