Nystagmus is a condition when the eyeball makes rapid and repetitive movements involuntarily. This condition can cause visual disturbances, such as blurred or unfocused vision.

When nystagmus occurs, the eyeball can move in all directions, be it horizontal, vertical or rotating. This will interfere with visual acuity and the sufferer's perception of an object. As a result, sufferers can experience disturbances in the coordination of movements.

Causes of Nystagmus

Nystagmus can occur due to heredity (genetic) or as a symptom of certain health disorders. The disorder in question can occur in the part of the brain or inner ear that regulates eye movement.

Broadly speaking, nystagmus is divided into two categories, namely:

Infantile nystagmus syndrome  (INS)

INS is a nystagmus that occurs due to hereditary factors. This condition is often experienced by infants aged 6 weeks to 3 months. INS is generally mild and tends not to get worse. Therefore, many parents of children with INS are not aware of this condition.

In rare cases, INS is triggered by albinism of the eye (ocular albinism), incomplete development of the optic nerve ( optic nerve hypoplasia ), and absence of an iris in the eye (aniridia).

Acquired nystagmus

Acquired nystagmus  is nystagmus that occurs due to health problems or other diseases. Acquired nystagmus  can affect how the brain, ears and balance work.

A number of conditions that have the potential to cause  acquired nystagmus are:

  • Head injury
  • Excessive consumption of alcoholic beverages
  • Paraneoplastic syndrome due to cancer
  • Inner ear diseases, eg  Meniere's disease and labyrinthitis
  • Eye diseases, such as cataracts and lazy eye
  • Disorders in the brain, such as  multiple sclerosis  brain tumors, or strokes
  • Hypomagnesemia or lack of magnesium in the blood
  • Side effects of certain medications, such as phenytoin, carbamazepine, or barbiturates
  • Deficiency of vitamin B12
  • Strokes

Nystagmus Symptoms

The hallmark symptom of nystagmus is rapid, uncontrollable movement of the eyeballs. In general, the eye moves horizontally (side to side), but can also move vertically (up and down) or torsion (rotating).

Nystagmus  usually occurs in both eyes, but can occur in only one eye. The speed of the eyes when rotating also varies in each patient.

Other symptoms that people with nystagmus can experience include:

  • Dizzy
  • vertigo
  • Impaired vision
  • Balance disorders
  • The eyes become more sensitive to light
  • Feel the vibrations on the stand
  • Hard to see in the dark
  • Loss of consciousness

When to see a doctor

Nystagmus caused by heredity tends to be mild and not a serious medical condition. However, be aware of nystagmus caused by serious conditions, such as a head injury, drug poisoning, stroke, or disorders that affect the brain.

Immediately call the ambulance service on 119 if you see someone experiencing the above symptoms, especially if they are accompanied by symptoms of a life-threatening condition, such as:

  • The pupils of the eyes are abnormal in size and do not react to light
  • Speech is slurred, slurred, or unable to speak
  • Very bad headache
  • Sudden weakness
  • dazed
  • Fainting or loss of consciousness

Diagnosis of Nystagmus

Diagnosis of nystagmus begins with a question and answer session regarding the patient's medical history and drug consumption history, or other factors that can trigger nystagmus.

The doctor can suspect that the patient has nystagmus, if there are a number of the symptoms described previously. However, to be sure, the doctor will carry out a physical examination.

Physical examination is carried out by asking the patient to rotate for 30 seconds. After stopping spinning, the patient will be asked to stare at an object. In patients with nystagmus, the eyes will move slowly in one direction, then quickly in the opposite direction.

If needed, the doctor will carry out supporting examinations, such as:

  • Ear examination, to evaluate the function of the inner ear
  • Blood tests, to check whether the nystagmus is caused by a lack of vitamin B12 or other factors
  • Brain scan with  a CT scan or MRI of the head, to see if the nystagmus is caused by an abnormality in the structure of the brain
  • Electro-oculography , to measure the patient's eye movements using electrodes
  • Electronystagmography , to evaluate dizziness, vertigo, or nystagmus, by testing the reaction of the eyes to differences in head position, air, or water in the patient's ears

Nystagmus Treatment

The method of treating nystagmus depends on its type. Infantile nystagmus syndrome cannot be treated. However, patients can use glasses or contact lenses to help improve vision.

In severe cases of INS, the doctor will perform a  tenotomy procedure  to change the position of the muscles that control eye movement. Although it cannot completely cure nystagmus, this procedure can reduce the degree of visual impairment experienced by the patient.

Whereas in patients with acquired nystagmus , the treatment given will be adjusted to the underlying cause, including:

  • Replace the drugs that are being consumed
  • Fulfilling vitamin intake
  • Give eye drops if there is an infection
  • Prescribing antibiotics for an inner ear infection
  • Provide special glasses
  • Carrying out brain surgery to treat central nervous system disorders
  • Give anti-seizure drugs, such as gabapentin , and muscle relaxants such as baclofen
  • Giving injections of  botulinum toxin (botox) to relax the eye muscles which results in abnormal eye movements

Nystagmus complications

Nystagmus that is not treated can result in decreased visual acuity and impaired coordination in sufferers. Nystagmus itself can be a sign of a serious condition, such as a head injury, stroke, or drug poisoning.

If you are diagnosed with nystagmus, it is important to take the treatment as recommended by your doctor. This aims to prevent complications, such as:

  • Brain damage
  • Impaired movement and balance of the body
  • Impaired cognitive ability
  • Paralysis
  • Permanent disability
  • Coma

Nystagmus Prevention

In general, there is no special prevention in cases of infantile nystagmus syndrome , which is a hereditary disease. However, in acquired nystagmus caused by certain conditions, prevention can be done by avoiding factors that can increase the risk of developing this condition, such as:

  • Avoid head injuries by wearing a helmet or seat belt while driving
  • Avoid consuming alcoholic beverages
  • Fulfilling vitamin intake
  • Adopting a healthy lifestyle, including consuming nutritious food and drinking enough
  • Stop using drugs that can trigger nystagmus and replace them with other treatments according to doctor's advice
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