Eye health resource
Nystagmus 101: Cause, Symptoms and Treatment
Nystagmus is involuntary rhythmic eye movement. Learn about infantile and acquired forms, possible causes, symptoms, evaluation, and treatment options.
Reviewed for accuracy by Justin Bazan, OD on .
Nystagmus is an involuntary, repetitive movement of one or both eyes. The movement may be side to side, up and down, rotary, or a combination, and the effect on vision varies greatly from person to person.
Nystagmus is not usually explained by one single cause. Some forms begin in infancy and may be associated with inherited or developmental eye conditions. Other forms start later in life and can be related to the inner ear, brain, medications, alcohol or drugs, or other medical conditions.
What Is Nystagmus?
Nystagmus describes a pattern of involuntary eye movement. It can affect the ability to maintain steady fixation and may reduce visual acuity or cause an abnormal head position when a person discovers a gaze direction in which the movement is less noticeable.
Some people with longstanding infantile nystagmus do not perceive the world as moving. People who develop nystagmus later in life are more likely to experience oscillopsia—the sensation that the environment is moving or bouncing.
What Are the Main Types?
Infantile Nystagmus
Infantile nystagmus usually begins within the first months of life. It may occur without another identifiable eye disease, or it may be associated with conditions that reduce vision early in life, including albinism, retinal disorders, optic-nerve abnormalities, congenital cataract, or other ocular conditions.
It does not usually “disappear” as a child grows. The pattern and its visual effect may change over time, and children often learn visual strategies such as turning or tilting the head toward a position where the nystagmus is reduced.
Acquired Nystagmus
Acquired nystagmus begins later in childhood or adulthood. Causes can include vestibular or inner-ear disorders, neurologic disease, stroke, head injury, multiple sclerosis, certain medications, or alcohol/drug effects.
New acquired nystagmus deserves medical evaluation. If it appears suddenly with weakness, numbness, severe headache, difficulty speaking, trouble walking, double vision, or other neurologic symptoms, emergency evaluation may be necessary.
What Symptoms Can Occur?
Symptoms depend on the type and cause and may include:
- involuntary rhythmic eye movement
- reduced or fluctuating visual clarity
- difficulty seeing in certain gaze positions
- a compensatory head turn or tilt
- light sensitivity
- reduced depth perception
- dizziness or imbalance when a vestibular problem is involved
- oscillopsia in some acquired forms
What Causes Nystagmus?
Possible causes or associated conditions include:
- inherited or idiopathic infantile nystagmus
- albinism and other developmental eye conditions
- retinal, optic-nerve, or other sensory vision disorders
- inner-ear or vestibular disease
- stroke or other neurologic disease
- multiple sclerosis
- head injury
- certain medications
- alcohol or other drug effects
The presence of nystagmus does not by itself tell you which cause is responsible.
How Is Nystagmus Evaluated?
An eye examination can document the eye-movement pattern, measure vision and prescription, and look for an ocular condition that may be contributing. The clinician will also ask when the movement began, whether it is constant or intermittent, whether the surroundings seem to move, and whether there are neurologic or balance symptoms.
Depending on the pattern and history, additional evaluation by ophthalmology, neuro-ophthalmology, neurology, or an ear/vestibular specialist may be appropriate. Some acquired cases require imaging or other medical testing.
Can Nystagmus Be Treated?
Treatment depends on the cause and on how much the nystagmus affects function. There is no single treatment that applies to everyone.
Management can include:
- the best eyeglass or contact-lens correction
- treatment of an associated eye, neurologic, or vestibular condition
- visual aids or low-vision rehabilitation when needed
- selected medications in certain types of nystagmus
- eye-muscle surgery in selected patients, often to reduce a significant compensatory head position rather than to “cure” the eye movement
For acquired nystagmus, treating the underlying cause may reduce or resolve the movement in some cases.
What Can Park Slope Eye Do?
Park Slope Eye can perform a comprehensive eye examination, measure refractive error, evaluate ocular health, and help determine whether further ophthalmic or neurologic evaluation is appropriate.
A child with newly observed abnormal eye movements should be evaluated rather than waiting to see whether the movement disappears. An adult with new nystagmus should also be assessed promptly, especially when it is accompanied by dizziness, imbalance, double vision, or neurologic symptoms.
Book an appointment if you or your child has longstanding eye movements that need evaluation. For sudden nystagmus with serious neurologic symptoms, seek urgent or emergency medical care.
Originally published . Substantially updated .