Nystagmus refers to involuntary, rhythmic oscillations of the eyes. It can be congenital or acquired due to neurological disorders or drugs. There are various types including downbeat, upbeat, jerk, and latent nystagmus. Symptoms depend on whether the condition is congenital or acquired. Examination involves assessing vision, refraction, and motility recording. Treatment options include correcting refractive errors, using contact lenses or prisms, and stimulating accommodative convergence.

1. Nystagmus
Presenter: Surendra sah
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2. Definition
 Refers to a disturbance of ocular posture, which consists of
involuntary rhythmic to- and -fro oscillation of the eyes.
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3. ETIOLOGY
 May be congenital
 Idiopathic
 Secondary to a pre-existing neurological disorder
 May be induced temporarily by certain drugs (alcohol and
other central nervous system depressants and stimulants,
such as lithium salts,).
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4. TYPES
 Downbeat
 Horizontal
 Jerk
 Latent/manifest
 Miner’s
 Pendular
 Physiological
 See-saw
 Torsional
 Upbeat
 Vertical
 optokinetic
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5. Down beat Nystagmus
 In primary position of gaze,the fast component is downward
 Associated with posterior fossa disease
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6. Up Beat Nystagmus
 Up beat Nystagmus-primary position of gaze,the fast
component is upward.
 Usually seen in lesions of central tegmentum of brain stem
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7. Jerk Nystagmus
 The movement consists of slow phase in one direction
followed by a quick phase in opposite direction
 The slow movement is fundamental one and the rapid jerky
saccadic movement is a compensatory one to regain
fixation
 Right, Left, Up and Down
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8. Latent Nystagmus
 Only appeared when one eye is closed
 Occurs when the eyes are directed laterally
 No obvious pathological condition of the media ,fundi
or visual tract
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9. Miner’s Nystagmus
 Occurs in coal mine workers
 Usually pendular type
 Purely horizontal
 oblique
 Result from fixation difficulties in dim illumination in
association with a disturbance of the vestibular apparatus
 Exposures to noxious gases
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10. See saw Nystagmus
 One eye rises up and intorts
 Other shifts down and extorts
 Associated with upper brain stem lesion
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11. Physiological vestibular
Nystagmus
 jerk horizontal Nystagmus seen in normal persons which
can be elicited by stimulating the tympanic membrane
with hot or cold water.
 Extreme right or left gaze
 Its forms the basis of caloric test
 If cold water is poured into right ear the patients develops
left jerk nystagmus while the reverse happens with warm
water i.e patients develops right jerk nystagmus.
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12. Features of Nystagmus
movements
 Pendular and jerky
 Conjugate and disconjugate
 Rapid and slow
 Null zone and neutral zone
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13. Pendular Nystagmus
 Characterized by the movements which are of equal
velocity in each direction
1. Horizontal
2. Vertical
3. Oblique
4. Rotatory and mixed
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14. Cont…
 Conjugate Nystagmus—is binocular with oscillations that
are in phase in regard to amplitude ,frequency and
direction of movement
 Disconjugate Nystagmus-(binocular)the frequency,
amplitude or direction of the slow components is out of
phase
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15. Null Zone
 Refers to the position of eyes where a zerk Nystagmus is
absent or minimum
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16. Neutral zone
 The point from where fast component of Nystagmus
changes its direction
 May be same or different than the null zone
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17. Ocular fixation Nystagmus
 Ocular Nystagmus is due to a defect of central vision
which makes fixation difficult or impossible
1. Physiological
2. Pathological
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18. Deviational Nystagmus-
 eyes are deviated to there extreme limit beyond the extent
of field of binocular fixation
 it occurs if there is paresis of an extrinsic ocular muscle
 may be unilateral
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19. Optokinetic Nystagmus-
 Physiological jerk nystagmus induced by presenting to
gaze the objects moving serially in one direction .
 The eyes will follow a fixed strip momentarily and then
jerk back to reposition centrally to fix up new strip.
 Formally known as “rail road” Nystagmus
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21. Latent Nystagmus-
1. Only appeared when one eye is closed
2. Occurs when the eyes are directed laterally
3. No obvious pathological condition of the media ,fundi or
visual tract
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22. Pathological ocular nystagmus
 Deviational Nystagmus
 Nystagmus due to blindness-
1. Occur in persons who have been blind for some time
2. Movement especially in the case of an infant born blind,
may be irregular, variable & in large excrusion
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23. Due to defective central vision
 Noticed in the first few month of the life when child begins
to develop central fixation
 Common cause : Albinism ,congenital or infantile
anomalies in the eye media or macular region of the retina
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24. Spasmus Nystagmus
 Associated with head nodding movements
 @ the age of 6 or 7 months & persisting for not more than
a year
 It is Pendular & of rapid frequency
 It may be horizontal, vertical ,Rotatory
 Visual acuity is usually poor
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25. Congenital idiopathic
Nystagmus
Typically Pendular
Usually horizontal & do not alter on
latero-version
Varies with the emotions
No clinical evidence of any disease
Defect of central vision
Distance vision is more effected than
near
May be hereditary
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26. Frequency of Nystagmus-
 Slow (1-2 Hz)
 Medium (3-4Hz)
 Fast (5Hz or more)
 Recorded by electronystagmography
Amplitude of nystagmus
 Small <5 degrees
 Medium= 5 to 15 degrees
 Large >15
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27. Symptoms
Depends upon-
 Whether the condition is congenital origin
 Whether the condition is acquired
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28. CLINICAL EXAMINATION
 History
 Vision
 Refraction
 Motility recording
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29. Medical history
When was it first noticed?
How often does it occur?
Has it ever happened before?
Is it getting better, worse, or staying the same?
Are there side-to-side eye movements?
Are there up-and-down eye movements?
What medications are being taken?
What other symptoms are present?
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30. vision
 V.A is better when tested with both eyes simultaneously than when
each eye is tested individually because of appearance of nystagmus
on occluding one eye
Special methods –
• Blurring the non –tested eye with a +6.0 to +8.0 D lens
• Using polarizing lenses and polarized charts
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31. TREATMENT
1. Correcting the high refractive error
Retinoscopy –Null point
2. Contact lenses
 CL move with movements of eye and so the visual axes always
coincides with their optical axis
 Cl – decreases nystagmus
3. Prismotherapy
 Base –out prisms may stimulate fusional convergence –
improve V.A by dampening the nystagmus
 Prisms with base opposite to preferred direction of gaze may
helpful in correcting the head posture.
4. stimulating accommodative convergence –overcorrecting of
minus lens
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