Specialists in Nystagmus
3 Specialists found
Information About the Field of Nystagmus
What is nystagmus?
Nystagmus is a term to describe an involuntary, rhythmic movement of the eyes. This eye tremor can occur naturally and without being a sign of illness. It serves the purpose of keeping an object focused on the retina, even when the object or the observer is moving. This mechanism helps maintain a stable image despite movement.
Nystagmus consists of a slow movement that follows the object and a rapid corrective movement. The direction of this rapid movement defines the direction of the nystagmus.
However, this involuntary eye movement can also have medical significance. In such cases, it is referred to as pathological nystagmus. Since it can indicate damage in certain areas of the brain, the underlying cause should always be thoroughly examined.
How does nystagmus occur?
Physiological nystagmus, which occurs naturally and is not a sign of illness, is caused by a complex interaction between different cranial nerves that control vision and eye movement. The initial signal comes either from the eyes and optic nerves themselves or from the balance system in the inner ear. It is triggered whenever we follow a moving object with our eyes or when we move ourselves.
On the contrary, pathological nystagmus happens when the balance system or other parts of the brain incorrectly send signals as if movement is occurring when it is not. As a general rule, any nystagmus that occurs while at rest is considered pathological and should be thoroughly examined.
Congenital nystagmus
Nystagmus can be congenital, appearing within the first few weeks of life. This condition is referred to as infantile nystagmus. In many cases, the eye movements are not exactly horizontal but may deviate irregularly in various directions. Both eyes are usually affected equally.
The exact cause is still unknown, but it is thought to involve dysfunction in the midbrain. Tumors or other neurological diseases are rarely found as causes.
A special form of infantile nystagmus is latent nystagmus, which is associated with strabismus (crossed eyes) and impaired binocular vision. This type of nystagmus appears when one eye is covered and disappears when the cover is removed.
Neurological causes
Several neurological conditions can cause nystagmus. It may result from damage or dysfunction in one of the two balance organs in the inner ear, but it can also originate from disorders affecting the cerebellum or brainstem.
Other possible causes include conditions that affect the central nervous system, such as multiple sclerosis, Parkinson’s disease, brain tumors, previous strokes, or head injuries.
Psychological causes
Psychological stress can lead to a wide range of physical symptoms. While stress alone is unlikely to directly cause nystagmus, people experiencing chronic stress may be more prone to developing it.Certain medications, such as antidepressants or sedatives, can also trigger nystagmus as a side effect. Additionally, some drugs, such as ecstasy (MDMA), have been linked to nystagmus as well.
What are the most common types of nystagmus?
In addition to the general classification of nystagmus into physiological (normal) and pathological (disease-related) forms, eye movements can also be categorized based on their underlying causes.
Vestibular nystagmus
Vestibular nystagmus itself is not considered a disease. It occurs when the balance organs (vestibular system) in both ears detect body movement. To maintain a stable image of the surroundings despite this motion, the eyes rhythmically move back and forth. Since the balance organs function independently of what is seen, this type of eye movement can also occur even when spinning on a chair with closed eyes.
Optokinetic nystagmus
Optokinetic nystagmus helps the eyes track moving objects. It is sometimes referred to as "railway nystagmus" because it occurs when a person watches the scenery pass by while looking out of a moving train window. This is a completely normal physiological reaction.
Spontaneous nystagmus
Spontaneous nystagmus includes pathological forms of involuntary eye movement that occur at rest, without any specific trigger. The cause may lie in the brain, the balance organs, or the nerve pathways outside the brain tissue.
If spontaneous nystagmus is due to a vestibular disorder, it is called vestibular spontaneous nystagmus. This can occur if one of the balance organs fails, as seen in Ménière’s disease. Nystagmus can also appear in benign paroxysmal positional vertigo (BPPV), which is caused by displaced tiny crystals in the inner ear’s balance system.
Fixation or gaze-evoked nystagmus
Fixation nystagmus which is also known as gaze-evoked nystagmus, is another pathological type of involuntary eye movement. Instead of improving when focusing on an object, the nystagmus worsens. The cause may be congenital or result from neurological diseases acquired later in life. Infantile nystagmus is often classified under this type of involuntary eye movement.
What are the typical symptoms of nystagmus?
Since nystagmus simply refers to the involuntary, rhythmic movement of the eyes, it is technically a symptom rather than a standalone medical condition. However, pathological forms of nystagmus can be accompanied by other symptoms.
If vestibular issues are the underlying cause, nystagmus often occurs along with double vision, dizziness, headaches, or even nausea. These symptoms arise because the brain detects a mismatch between what the eyes see and the signals received from the balance system in the inner ear.
In cases of infantile nystagmus, a child may develop a persistent head tilt as they unconsciously try to compensate for their vision problems.
When nystagmus is a symptom of an underlying medical condition, additional symptoms related to that condition may also appear alongside eye movement abnormalities and the issues mentioned above.
How does a specialist diagnose nystagmus?
Physiological forms of nystagmus have no medical significance and do not require diagnostic evaluation. All other types of nystagmus, however, should be thoroughly examined to identify their cause.
The diagnostic process always begins with a detailed medical history. This includes getting information about the patients known underlying conditions. These can be important clues about the possible cause of the nystagmus. Depending on the suspected diagnosis, different clinical tests may be used.
In many cases, the caloric test is performed to assess the responsiveness of the balance organs. This test takes advantage of the fact that the vestibular system reacts to temperature changes. During the procedure, the patient lies on a reclining chair with their upper body slightly elevated, while the outer ear canal is irrigated with either warm or cold liquid. In some cases, air at specific temperatures is used instead. The doctor then closely observes the patient’s eye movements. Typically, the patient wears special goggles that prevent them from seeing, while allowing the examiner to see their eyes magnified. If there is a difference in eye movement responses between the two balance organs, it may indicate a vestibular disorder.
Depending on the results of the caloric test and the suspected diagnosis, additional neurological examinations, such as brain imaging or nerve conduction tests, may be performed to further investigate the underlying cause.
What therapy options are available for nystagmus?
The treatment of nystagmus always depends on the underlying cause. Priority should be given to treating the underlying disease. If it is suspected that certain medication is the possible cause, it should be discontinued or replaced with another medication if possible.
The treatment of nystagmus always depends on the underlying cause. Priority should be given to treating the underlying disease. If it is suspected that certain medication is the possible cause, it should be discontinued or replaced with another medication if possible.
The use of medication to treat nystagmus is currently a controversial issue. Sometimes, the use of medication that is normally effective against nerve pain can lead to relief of symptoms. The benefits and risks must be carefully weighed against each other.
Other conservative treatment approaches include lifestyle changes such as avoiding smoking and alcohol and reducing stress. Certain eye exercises can also help patients to improve eye tremors.
Congenital forms of nystagmus can sometimes improve on their own during the first year of life. However, more severe cases often cannot be managed effectively with conservative treatments alone. In such situations, surgery may be considered to prevent complications and improve the patient’s quality of life. This typically involves adjusting the eye muscles through a procedure similar to strabismus surgery, allowing for better eye alignment. In addition, temporarily covering one eye or wearing glasses may also be necessary.
What are the risks of surgery?
As with any surgical procedure, there are risks. Bleeding or postoperative infection can occur during an eye muscle surgery. To minimize these risks, you should avoid strenuous physical activity after the operation. In addition, various eye drops or ointments are prescribed to support the healing process.
Another possible side effect of the surgery can be pain when moving the eyes, typically in first two days. This can generally be treated with painkillers.
Due to the continuous development of surgical techniques and increasing experience with this type of surgery, surgery on the eye muscles is generally a low-risk procedure.
How is nystagmus managed after treatment?
If conservative treatment methods are used, regular medical check-ups are essential to assess the effectiveness of the therapy and make adjustments or add alternative treatments if needed.
When nystagmus is treated through eye muscle surgery, the procedure is usually performed on an outpatient basis. After a short observation period, patients are typically allowed to return home. The first follow-up appointment usually takes place the next day.
During the first few weeks following the surgery, patients should avoid strenuous physical activity and refrain from bathing or swimming to reduce the risk of infection. After a few weeks, these restrictions are generally no longer necessary. The alignment of the eyes and any remaining nystagmus are regularly monitored through follow-up examinations.
What are the chances of recovery and the prognosis of nystagmus?
There is no universal prognosis for nystagmus, as the chances of recovery depend on the underlying cause.
For example, nystagmus caused by Ménière’s disease can persist for several years or, in some cases, resolve on its own within the first two years.
If surgical correction is required for congenital nystagmus, the outlook is generally very good. However, many patients will still need to wear glasses throughout their lives.
Which doctors & clinics specialize in nystagmus?
As nystagmus can have multiple causes, its treatment falls under different medical specialties. The first point of contact is usually an ophthalmologist, also known as an eye doctor, who can perform the necessary diagnostic tests and, if needed, carry out eye muscle surgery.
For vestibular nystagmus, the ENT (ear, nose, and throat) specialists are the most qualified to provide treatment. If the eye movement disorder is caused by a neurological condition, then a neurologist would be responsible for managing the treatment.
Our goal is to connect patients with specialists who have expertise in diagnosing and treating their specific condition. This ensures high-quality medical care based on the latest scientific research.
All the doctors listed here have been carefully reviewed and evaluated for their expertise in treating nystagmus. They are highly experienced in their respective fields. Take advantage of their specialized knowledge and easily get in touch with one of our experts.
Sources:
- Franz Grehn: Augenheilkunde. 32. Auflage. Springer-Verlag 2019.
- Werner Hacke: Neurologie. 14. Auflage. Springer-Verlag 2019.
- www.kindernetzwerk.de/images/glossar/Krankheitsbeschreibungen/Nystagmus.pdf
- www.pschyrembel.de/Fixationsnystagmus/
- Bundesverband für ambulantes Operieren e.V. -https://www.operieren.de/content/e3224/e10/e589/e594/e596/#e610
- Leitlinien für Diagnostik und Therapie in der Neurologie: S1-Leitlinie zu Augenbewegungsstörungen inkl. Nystagmus. Stand September 2021.
Amboss, Nachschlagewerk für Mediziner.-https://next.amboss.com/de/article/Go0BWS?q=nystagmus#Z658d734ecda2565fc33ab7f1e8da7435