Types of nystagmus
Doctors divide nystagmus according to the time of occurrence, direction and nature of movements. The congenital one most often becomes noticeable in the first months of life and usually remains horizontal even when looking up. The acquired one appears later and is often accompanied by the feeling that objects around are shaking. Physiological nystagmus is distinguished separately: it occurs in healthy people when tracking fast moving objects or with extreme abduction of the eyes and is not considered a pathology.
- Congenital (infantile) - from the first months of life
- Acquired - appears later, more often in adults
- Pendulum-shaped - oscillations of the same speed in both directions
- Jerky - slow phase and fast return
- Vestibular - with damage to the inner ear
- Physiological - a variant of the norm when tracking movement
Reasons
In children, the main reason is conditions in which the retina does not receive a clear image from birth: congenital cataracts, corneal opacities, severe myopia, albinism, underdevelopment of the optic nerve. The visual system does not have time to develop a mechanism for fixing gaze. In adults, nystagmus often indicates damage to the inner ear, brain stem or cerebellum: this could be vestibular neuritis, Meniere's disease, multiple sclerosis, stroke, tumor. A separate reason is the side effects of some anticonvulsants and sedatives, as well as alcohol.
- Congenital diseases of the eyes and optic nerve
- Albinism and hereditary forms
- Diseases of the inner ear and vestibular nerve
- Lesions of the brainstem and cerebellum
- Multiple sclerosis, stroke, tumors
- Side effects of medications, alcohol, vitamin B1 deficiency
Symptoms
The main manifestation is noticeable from the outside: the eyes continuously make small oscillatory movements. With the congenital form, a person, as a rule, does not see that the world is fluctuating, because the brain has adapted from birth; visual acuity is reduced. Many people find a head position in which shaking is minimal and keep their head turned or tilted - this is called the forced position. Acquired nystagmus, on the contrary, is characterized by oscillopsia: a feeling that objects are swaying, and it greatly interferes.
- Visible vibrations of the eyeballs
- Decreased visual acuity
- Forced turning or tilting of the head
- The feeling of vibration of surrounding objects with the acquired form
- Dizziness and unsteadiness due to vestibular causes
- Increased trembling with excitement and fatigue
What examinations are needed
The ophthalmologist checks visual acuity, refraction with pupil dilation, examines the fundus and evaluates the nature of eye movements: direction, amplitude, presence of a rest zone. This helps distinguish an ocular cause from a neurological cause. In case of acquired nystagmus and any additional complaints, an MRI of the brain is required, if necessary, focusing on the area of the posterior cranial fossa. If there is dizziness and hearing loss, an ENT doctor is involved with vestibular tests and a hearing assessment. Sometimes studies that record eye movements are needed.
- Complete ophthalmic examination with dilation
- Assessing the direction and nature of nystagmus, searching for a rest zone
- MRI of the brain
- Neurologist consultation
- Vestibular tests and hearing assessment
- Review of medications taken
Treatment
There is no universal way to eliminate nystagmus: the cause is treated first. For vestibular neuritis or Meniere's disease, appropriate therapy and vestibular rehabilitation help; For drug-induced nystagmus, the doctor adjusts the medications. Congenital nystagmus is not completely eliminated, but vision can be significantly improved: properly selected glasses or lenses make the image clearer and reduce the amplitude of oscillations; prismatic glasses help reduce forced rotation of the head. If there is a pronounced forced position of the head, surgery on the extraocular muscles is discussed, which shifts the rest zone to a straight position.
- Treatment of the underlying disease
- Precise optical vision correction
- Contact lenses, which are often better tolerated than glasses
- Prismatic correction of forced head position
- Surgery on the extraocular muscles according to indications
- Cancellation or replacement of drugs that cause nystagmus only by a doctor
