case of congenital nystagmus

1. Case Presentation

2. Name: XYZ
Age: 6 years
Gender: Male
MR No: 984318
Date: 14/6/18
Address: Mumbai

4. Patient is wearing glasses
since five years and last
glasses were changed 5-6
months ago.

6. Birth History
Patient had Full Term Normal Delivery with a 3 kg
Birth weight.
Patient was fully vaccined after birth.

7. There was no history of pain,
Itching, watering and foreign
body sensation.
The patient had not met with
any accident.
Patient had not undergone any
ocular surgery.
Patient does not have any other
associated systemic disease
and no allergy to any

8. Vision RE LE
Vn with glasses 6/60 6/60

9. Torch light examination
The patient on torch light
examination was seen to have
nasally eccentric pupil and face
was turned on left side but the
pupil was round, regular and
reacting to light and was found
to have nystagmus as there was
involuntary movement of eyes.

11. Ocular motility :Full

12. Cover Test : Orthophoria

13. FundusExamination
On fundus examination patient’s Retina and
Macula is within normal limits but there were
few internal limiting membrane striae means
at some of the area Internal limiting
membrane is peeled off and the patient’s
optic disc is hyperemic.

14. Diagnosis

15. +8.5
When the patient was shown at Krishna hospital in June 2015
 Patient was diagnosed with the following:
Moderately turning of face towards left side.
Hirschberg test: Left eye esotropia
Cover test: Left eye esotropia.
EOM: Full
Low amplitude Horizontal pendular nystagmus.
Anterior segment: Within normal limits.
 Patient was advised for squint surgery and occlusion of Right
eye and reduction of abnormal head posture.
 Investigation:
 Subjective test:
RE: +7.00/-2.00*180 Vn: 6/36
LE: +7.00/-1.75*160 Vn: 6/60
 Undilated Retinoscopy at 50cm :
RE LE
+8.00
+7.00+6.00
 Treatment:
 Both eye
New
glasses
 Reassured
 Expalined
about
schooling
 Letter to
school
given.
+8.5

16.  PG:
RE: +6.5/+1.00*95
LE: +6.5/+1.00*80
 Subjective Refraction:
RE: +4.0/+2.0*90 Vn: 6/60
LE: +5.0/+1.5*90 Vn: 6/60
Pinhole Vn: Cant appreciate
Near Vn:
BE: N36 reads at 40 cms
 Dilated Both eye with Cyclo-
Tropica-Cyclo(CTC)
 Objective refraction:
Dilated Retinoscopy at 50 cm
 Gross retinoscopy
RE LE
 Net Retinoscopy
RE: +5.5/+2.0*90
LE: +5.0/+1.5*90
+7.5
+9.0
+7.0
+9.0
Refraction

17. First Follow Up on 28-12-
18 ST :
RE: +5.0/+2.0*90 Vn:6/60
LE: +5.0/+1.5*90 Vn:6/60
Near Vn:
BE: N18
 PG: Broken
RE: +4.00/+2.00*75
LE: +4.50/+1.50*70
 Patient having Horizontal pendular Nystagmus having orthophoria
for distance and esotropia for near and EOM full.
 Both eye dilated with Cyclo-Tropica-Cyclo(CTC)
 Dilated Retinoscopy at 50 cm:
 Gross retinoscopy
RE LE
+8.0
+10.0
+8.0
+9.5
 Net Retinoscopy
RE: +6.5/+2.0*90
LE: +6.5/+1.5*90
 Net Retinoscopy with
cyclo Deduction
RE: +5.75/+2.0*90
LE: +5.75/+1.5*90

18. Patient’s Intraocular pressure within
normal limits.
Patient has moderate refractive error
so can try contact lens.
Patient was advised to have glasses
for both eye and was reviewed to
clinic after 8 months.
First Follow Up on 28-12-18

19. DiscussionNystagmus is the term used to describe involuntary
repetitive eye movements that make it impossible for a
person to keep their eyes fixed on any given object.
There are two basic types of nystagmus:
• the eyes make a
very quick
movement in one
direction, followed
by a slower
movement in the
opposite direction.
Jerk
nystagmus
the eye
movements are
of equal velocity
in each direction.
Pendular
nystagmus
Nystagmus is usually infantile,
meaning people have it from a
very early age. Experts say that
about one child out of every
several thousand has nystagmus.

20. •Congenital nystagmus
•Manifest nystagmus
•Latent nystagmus
•Manifest-latent nystagmus
•Acquired nystagmus
Nystagmus Classificatio

21. is present at birth. With this condition, your eyes move together as
they oscillate (swing like a pendulum). Most other types of infantile
nystagmus are also classified as forms of strabismus, which
means the eyes don't necessarily work together at all times.
is present at all times,
whereas latent
nystagmus occurs only when
one eye is covered.

22. 3.Manifest-latent nystagmus
is continually present, but worsens
when one eye is covered.
4.Acquired nystagmus
can be caused by a disease (multiple
sclerosis, brain tumor, diabetic neuropathy),
an accident (head injury), or a neurological
problem (side effect of a medication, for
example).
Hyperventilation, a flashing light in front of
one eye, nicotine and even vibrations have
been known to cause nystagmus in rare
cases.
Some types of acquired nystagmus can be
treated with medications or surgeries.

23. What causes nystagmus?
Nystagmus is most commonly caused by a neurological problem that is present at
birth or develops in early childhood. Acquired nystagmus, which occurs later in life,
can be the symptom of another condition or disease, such as stroke, multiple sclerosis
or trauma.
Other causes of nystagmus include:
•Lack of development of normal eye movement control early in life
•Albinism
•Very high refractive error, for example, nearsightedness (myopia) or astigmatism
•Congenital cataracts
•Inflammation of the inner ear
•Medications such as anti-epilepsy drugs
•Central nervous system diseases

25. How is nystagmus treated?
While eyeglasses and contact lenses do not correct the nystagmus itself,
they can sometimes improve vision. Using large-print books, magnifying
devices and increased lighting can also be helpful.
Some types of nystagmus improve throughout childhood. Rarely, surgery is
performed to change the position of the muscles that move the eyes. While
this surgery does not cure nystagmus, it may reduce how much a person
needs to turn his or her head for better vision.
If another health problem is causing the nystagmus, your optometrist will
often work with your primary care physician or other medical specialists to
treat that underlying cause.