Nystagmus

pp. 336-337 Comprehensive Ophthalmology, Khurana, 4
KFTABZ,2018

Definition
• regular and rhythmic to-and-fro involuntary
oscillatory movements of the eyes - Khurana
• repetitive, rhythmic oscillations of one or both eyes
in any or all fields of gaze- V & A
Nystagmus

• due to disturbance or abnormality in any of the factors
responsible for regulate normal ocular posture and
movement:
Nystagmus
Etiology
Sensory visual pathway
Vestibular apparatus
Midbrain and cerebellum

• A nystagmus may be:
Nystagmus
Features
pendular or jerk nystagmus
rapid or slow
fine or coarse
Latent or manifest
pendular movements of equal velocity in each
direction; may be horizontal, vertical or rotatory
Jerk slow component in one direction and a fast
component in the other direction.
- Defined by the direction of the fast component;
may be right, left, up, down or rotatory.

https://www.youtube.com/watch?v=UPYqd31hhfE&t=3s
Types of Nystagmus
PHYSIOLOGICAL
NYSTAGMUS
SENSORY DEPRIVATION
(OCULAR) NYSTAGMUS
MOTOR IMBALANCE
NYSTAGMUS (9)
 Optokinetic Nystagmus
 Endpoint Nystagmus
 Physiological Vestibular
Nystagmus
 Congenital Pendular
(ocular) Nystagmus
 Acquired Ocular
Nystagmus
 Miner’s Nstagmus
 Congenital Jerk
Nystagmus
 Latent Nystagmus
 Spasmus Nutans
 Peripheral Vestibular
Nystagmus
 Central Vestibular
Nystagmus
 Upbeat Nystagmus
 Down beat Nystagmus
 Periodic Alternative Nystagmus
 Gaze- Paretic Nystagmus
 Convergence Retraction Nystagmus
 See-saw Nystagmus
 Nystagmus blockage syndrome

 a physiological jerk nystagmus
 induced by presenting to gaze the
objects moving serially in one
direction, such as strips of a
spinning optokinetic drum
 The eyes will follow a fixed strip
momentarily and then jerk back to
reposition centrally to fix up a new
strip.
 Similar condition occurs while
looking at outside things from a
moving train.
OPTOKINETIC NYSTAGMUS
PHYSIOLOGICALNYSTAGMUS

 fine jerk horizontal nystagmus
seen in normal persons on
extreme right or left gaze
ENDPOINT NYSTAGMUS

 a jerk nystagmus which can be elicited
by stimulating the tympanic membrane
with hot or cold water.
 basis of caloric test
 ‘COWS’ (Cold–Opposite, Warm–Same)
 If cold water is poured into right ear the
patient develops left jerk nystagmus (rapid
phase towards left), while the reverse
happens with warm water, i.e., patient
develops right jerk nystagmus
PHYSIOLOGICAL VESTIBULAR NYSTAGMUS

 A horizontal slow pendular nystagmus
usually associated with sensory deprivation
due to reduced central visual acuity
 common causes:
 congenital cataract
 congenital toxoplasmosis
 macular hypoplasia
 Aniridia
 Albinism
 optic nerve hypoplasia
 Leber’s congenital amaurosis
CONGENITAL PENDULAR (OCULAR) NYSTAGMUS
SENSORYDEPRIVATION(OCULAR)NYSTAGMUS
Aniridia
Albinism

• occurs in monocular adults when they
develop decreased visual acuity in the
only seeing eye
• pendular
ACQUIRED OCULAR NYSTAGMUS
Director Nick Fury
S.H.I.E.L.D.

• rapid rotatory type
• occurs in coal mine workers
• probably results from fixation difficulties
in the dim illumination
MINER’S NYSTAGMUS

• a hereditary nystagmus of unknown
etiology which persists throughout life
• bilateral, horizontal jerk nystagmus with
rapid phase towards the lateral side
• not present during sleep
CONGENITAL JERK NYSTAGMUS
MOTORIMBALANCENYSTAGMUS

• not present when both eyes are open
• appears when one eye is covered
• a jerk nystagmus with rapid phase
towards the uncovered eye
LATENT NYSTAGMUS

• special type of acquired nystagmus in
childhood
• In its complete form triad:
• TORTICOLLIS
• PENDULAR NYSTAGMUS
• HEAD NODDING
• fine pendular horizontal nystagmus
• Signs usually develop within the 1st yr or
2 of life
• self-resolves by the age of 3 years
SPASMUS NUTANS

• due to diseases of the 8th nerve or
vestibular end organ
• jerky, fine, rapid and horizontal-rotatory
PERIPHERAL VESTIBULAR NYSTAGMUS

• may be of the following types:
a. Upbeat nystagmus
 the fast component is upward
 lesions of central tegmentum of brain
stem
b. Down beat nystagmus
 fast component is downward
 posterior fossa diseases and compression
at the level of foramen magnum
 cerebellar lesions and Arnold Chiari
syndrome.
c. Periodic alternative nystagmus
 jerk nystagmus
 shows fluctuations in amplitude and
direction
 may occur due to vascular or
demyelinating brain stem-cerebellar
lesions
CENTRAL VESTIBULAR NYSTAGMUS
a.
b.

• a slow horizontal jerk nystagmus due to
upper brain stem dysfunction
• Eyes jerk back to maintain eccentric gaze
GAZE-PARETIC NYSTAGMUS
(Not the legit illustration…)

• jerk nystagmus with bilateral fast
component towards the medial
side
• associated with retraction of the
globe in convergence
CONVERGENCE RETRACTION NYSTAGMUS

• one eye rises up and intorts, while
the other shifts down and extorts
• upper brain stem lesions
SEE-SAW NYSTAGMUS

• Rare condition
• sudden esotropia develops in
infancy to dampen the horizontal
nystagmus
NYSTAGMUS BLOCKAGE SYNDROME

Nystagmus
From Nelson 20th Ed (p3033)

1. Associated with lesions of central tegmentum of brain stem
2. posterior fossa diseases and compression at the level of foramen
magnum
3. Triad of torticollis, pendular nystagmus, and head nodding
4. Appears only when one eye is covered
5. Caused by aniridia, albinism, or congenital cataract
Short Term Memory Exercise
Brought to you by Dory
KEY
1.UpbeatNystagmus
2.DownbeatNystagmus
3.SpasmusNutans
4.LatentNystagmus
5.CongenitalPendularNystagmus

ありがとう
Arigatō
For additional reading:
Vaughn and Asbury
Nelson’s

Nystagmus

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