An Overview of Nystagmus

Why your eyes might "jump"

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Nystagmus is an eye condition characterized by rapid, jerking eye movements. It does not always cause any noticeable symptoms, but it can be associated with issues such as dizziness and vision problems. A number of different neurological illnesses can cause nystagmus. 

Typically, nystagmus is detected during a physical examination that involves an eye evaluation. It may be an early sign of a neurological condition, such as multiple sclerosis (MS), or it can develop as an already established neurological illness progresses. You may need treatment to help reduce your nystagmus and/or the accompanying effects. Most of the time, medical or surgical management of the underlying cause is necessary too. 

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Symptoms 

Nystagmus typically affects both eyes, but rarely it can affect just one eye. The jerking movements are not usually present all the time and nystagmus is often more noticeable when you are looking to one side or the other. In severe cases, eye jerking can be present all the time, even when you are looking straight ahead (not to the side).

Nystagmus looks like rapid, rhythmic, horizontal (side to side) motion of the eyes. Vertical (up and down) or rotary (moving in a circle) nystagmus can occur as well, but these patterns are not common.

Common symptoms of adult-acquired nystagmus (which differs from congenital nystagmus) include:

  • Dizziness 
  • Vertigo (a feeling that the room is spinning or that you are spinning) 
  • Diminished balance 
  • Nausea or vomiting 
  • Double vision or blurred vision 
  • Headaches, irritability 
  • A sense that visible objects are rhythmically jumping

You can experience all or some of these symptoms when you have nystagmus. Often, however, when nystagmus is present for a long time, the symptoms are not evident. 

Sometimes nystagmus can be so severe that it affects your balance. Sudden episodes (such as when it is induced by twirling) can make you so dizzy that you could fall and get hurt. 

Associated Symptoms 

If your nystagmus is caused by a neurological condition, you may also experience other effects. The associated symptoms are not necessarily caused by nystagmus and they do not cause nystagmus—instead, they are usually caused by the illness that triggered nystagmus (such as a brain tumor). 

Physical signs that may occur with nystagmus include:

  • Weakness on one side of the body 
  • Numbness or diminished sensation on one side of the body 
  • Severely impaired balance 
  • Tremors (shaking or jerking of the body) 
  • Impaired coordination
  • Vision deficits
  • Droopy eyelids
  • Memory loss or dementia 
  • Weight loss 

If you have any signs of nystagmus, you need to get medical attention. The neurological issues that are commonly associated with eye jerking can progressively worsen if they are not treated.

Causes 

Nystagmus is a symptom of some neurological illnesses and conditions that involve the inner ear. There are many neurological diseases that can be associated with eye jerking. Some of the conditions that cause nystagmus are serious and life-threatening, such as a brain tumor—and others are not associated with serious health risks, such as a lazy eye.

Common Risk Factors

The conditions that increase your risk of nystagmus do not always produce it—in fact, nystagmus is a relatively uncommon sign of neurological or inner ear disease.

Twirling: Twirling around in a circle for a few minutes and then stopping can cause a brief period of nystagmus that affects both eyes. This is generally harmless, but you may feel dizzy for minutes or even for the whole day afterwards. 

Strabismus (lazy eye): A congenital (from birth) defect may cause the eyes to be misaligned. This can cause a visibly obvious effect described as a lazy eye. Sometimes, nystagmus can occur with a lazy eye, especially when you look to the extreme left or right. 

Ménière’s disease: A condition characterized by episodes of severe vertigo, and possible hearing loss, Ménière’s disease is often associated with rhythmic eye jerking, especially during the attacks. 

Multiple sclerosis (MS): This condition can cause various neurological symptoms because it can affect different areas of the brain, spinal cord, and/or optic nerve (the nerve that controls vision). MS may cause permanent or intermittent episodes of nystagmus in one or both eyes. 

Brain tumor: A primary brain tumor (a tumor that starts in the brain) or a metastatic cancer from elsewhere in the body can invade or impinge on the cranial nerves, brainstem, or cerebellum in a manner that causes nystagmus to develop. 

Labyrinthitis: Inflammation of the inner ear is described as labyrinthitis. It can occur due to an infection, inflammatory disease, or it may be idiopathic (without an identifiable cause). This condition can cause profound dizziness, nausea, and vomiting—and your eye examination may show nystagmus. Generally, labyrinthitis is characterized by severe symptoms, but it is not typically associated with serious or life-threatening health risks. 

Stroke: An interruption in blood flow in the brain can cause brain damage. In rare instances, a stroke can result in nystagmus. 

Paraneoplastic syndromes: Several types of cancer can produce antibodies (immune cells) that attack a person’s own body, causing paraneoplastic syndrome, a rare cancer side effect. Nystagmus is one of the common symptoms of paraneoplastic syndromes. Ovarian cancers and adrenal cancers are examples of cancers that may have this effect. 

Congenital defect: Some children are born with nystagmus, and it may begin during infancy. The symptom can also occur during later childhood due to a hereditary condition. Childhood nystagmus can develop as a result of ocular albinism, an X-linked genetic disorder characterized by vision abnormalities and decreased pigment in the iris (the colored part of the eye around the pupil) of affected males.

Medications: Some medications can cause nystagmus as a side effect. Examples include Dilantin (phenytoin), Tegretol (carbamazepine), and barbiturates. These medications interfere with nerve function, and the nystagmus should wear off after the medication is metabolized from the body.

Alcohol: Alcohol intoxication can temporarily affect the nerves that control balance, resulting in coordination problems and nystagmus. 

Trauma: A traumatic injury can cause damage to the brain, nerves, or muscles that control eye movement, resulting in nystagmus.

Control of Eye Movements 

There are a few areas of the brain and inner ear that are involved with coordinating eye movements. A permanent injury or a temporary deficit involving any of these areas can interfere with normal eye movements, causing a number of potential vision and/or balance problems, including nystagmus. 

Nystagmus can result from impairment of any of the following structures:

Cerebellum: The cerebellum is the region of your brain that controls balance. Damage to the cerebellum, such as from a tumor or a stroke, may cause nystagmus. Additionally, the antibodies in paraneoplastic syndromes cause nystagmus by targeting the cerebellum. 

Cranial nerves: There are three pairs of cranial nerves that control muscles of eye movement (each eye is controlled by one nerve of each pair). Damage to these nerves can interfere with eye muscles, causing nystagmus.

  • The oculomotor nerve (cranial nerve three) controls several muscles that move your eyes—the superior rectus muscle, the medial rectus muscle, the inferior rectus muscle, and the inferior oblique muscle. These muscles move your eyes straight up and down, and towards your nose. 
  • The trochlear nerve (cranial nerve four) controls the superior oblique muscle, which move your eye on a direction that is down and away from your nose.
  • The abducens nerve (cranial nerve six) controls the lateral rectus muscle, which moves your eye outwards away from your nose. 
  • The vestibulocochlear nerve (cranial nerve eight) mediates your sense of sound and your sense of balance. It does not control eye movement, but a deficit in this nerve can impair balance to a degree that causes nystagmus. 

Brainstem: The cranial nerve fibers and the nerve fibers of the cerebellum run though the brainstem, an area of the brain that links the brain with the spinal cord. For this reason, disease that involves the brainstem (such as a hemorrhage or a stroke) may cause nystagmus. 

Inner ear: The inner ear contains many tiny structures that control hearing and help mediate balance. Inflammation, infections, and tumors involving the inner ear can cause nystagmus. 

Diagnosis 

Even if you have many of the associated symptoms, nystagmus is typically unnoticeable in day-to-day life. You are unlikely to notice your own jerky eye movements. It is very difficult to see your nystagmus in the mirror because the movements tend to be more intense when you look to the side. Sometimes, family or friends may notice your eyes jerking when they look at you.

Nystagmus is typically identified in a doctor’s office during a medical examination. Your doctor may check for nystagmus when doing a neurological examination during your yearly physical. Your eye muscles will be tested as you are asked to look towards each side with both eyes at the same time and to hold your gaze for a few seconds. Your eye doctor would also notice nystagmus during a routine eye examination (such as for your glasses or contact lenses).

If you have nystagmus, your medical team will do further tests to identify the cause and to see whether you have any worrisome complications.

Diagnostic examinations that you may need include: 

  • Eye examination: There are several steps in an eye examination. Your doctor will check your visual acuity (how well you can see close and far away objects), usually with an eye chart. You will also have an examination that includes measuring the distance between your pupils. This test can assess any differences in eye movement between your eyes and it can help identify a lazy eye. Your doctor may measure the speed and direction of your eye movements, and this assessment can include a video of your eye movements.
  • Brain imaging: Tests such as a brain computerized tomography (CT) or magnetic resonance imaging (MRI) can identify structural issues in the brain and inner ear, such as tumors and strokes. These conditions can affect the function of the cerebellum, cranial nerves, or inner ear, resulting in nystagmus. 
  • Electronystagmography (ENG): This diagnostic study is used to evaluate dizziness, vertigo, or nystagmus. ENG is a noninvasive test that objectively measures the function of your oculomotor and vestibular nerves, and it can help pinpoint whether one of these nerves is impaired.

Treatment 

There are several treatments used to help reduce the effects of nystagmus. Medications may be prescribed to specifically decrease the eye jerking movements. Sometimes, treatment is also needed to help lessen the associated nausea and dizziness. 

Additionally, if you have a neurological condition causing you to have nystagmus, you may need to use rehabilitative therapy for management of your neurological disease.

Vision Correction

If a vision deficit is causing you to have nystagmus, you may need to use corrective lenses to help correct your vision. In some situations, surgical vision correction is considered the best option.

Control of Eye Jerking 

Prescriptions used to diminish nystagmus include oral Firdapse (amifampridine), Lioresal (baclofen), Klonopin (clonazepam), and Neurontin (gabapentin). These medications may temporarily diminish your nystagmus, but they are not expected to cure it.

Symptomatic Therapies 

If dizziness, nausea, and/or vomiting are problematic for you, your doctor might recommend over-the-counter or prescription therapy to help alleviate these effects. 

Medical Management of Neurological Disease 

You may need to have medical therapy to treat the cause of your nystagmus. This can include disease-modifying therapy for management of MS, anti-inflammatory medication to manage Ménière’s disease, or antibiotics to treat an inner ear infection. 

Procedures

Botox (botulinum toxin) injections can be used to weaken and relax eye muscles. This is not the same as cosmetic botox, and it requires great care to avoid harming the eyes and the nearby structures.

Botulinum toxin weakens muscles, and when used for treatment of nystagmus, it reduces the compensatory nystagmus that occurs when the eye muscles are not of equal strength. 

In some situations, eye surgery can repair muscle defects that are causing nystagmus. You may need treatment for a brain tumor or an inner ear tumor. Treatment approaches for a tumor include surgical removal, radiation therapy, and/or chemotherapy. 

Rehabilitation 

Sometimes, therapy using rehabilitation techniques may be effective as a way to help strengthen your eye muscles. This can alleviate the problem if mild eye muscle weakness is the cause of your nystagmus. 

A Word From Verywell

Nystagmus is often a symptom of neurological disease. If your eye jerking is causing discomfort, you may need to have it treated. 

Sometimes nystagmus doesn’t cause any bothersome symptoms at all and it can be discovered incidentally (by chance) when your doctor is examining your eyes. There are times when nystagmus is the first clue that you have a neurological disorder. In these instances, you may need a thorough medical evaluation to identify the cause of your eye jerking. Treatment for the neurological conditions that cause nystagmus is usually necessary.

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