Navigating nystagmus

CPD
1
2 August 2024
Summer 2024

Kaye McIntosh on managing patients with nystagmus in the consulting room – patience is key in examinations.

Domains covered

Communication Clinical practice

Nystagmus – involuntary, repetitive eye movements that can cause visual loss (also known as “wobbly eyes” or “jerky eyes”) – is the most common form of visual impairment in school-age children (Nystagmus Network, 2024). Estimates of prevalence vary, but the widely cited Leicestershire study calculated it was 24 per 10,000 (Sarvananthan et al, 2009).

There are two major types of nystagmus: infantile or congenital (sometimes known as early-onset) and acquired. Babies with nystagmus usually show symptoms between six weeks and three months of age. One study estimated there are 6.72 paediatric cases per 100,000 population (Nash et al, 2017).

It’s often associated with visual deprivation in infancy caused by congenital cataracts or optic nerve hyperplasia. Other causes include ocular albinism, neurological conditions such as Down syndrome, retinal dystrophies or aniridia.

Infantile nystagmus is a lifelong condition that is often picked up by child health practitioners. One type, fusion maldevelopment nystagmus syndrome (FMNS), is strongly associated with strabismus, and this is often the reason parents come forward. Latent FMNS is only visible when one eye is covered. 

A form of acquired nystagmus called spasmus nutans is usually diagnosed between six months and three years. It typically improves without treatment between the ages of two and eight.

Simon Frackiewicz MCOptom, an optometrist at Robert Frith Optometrists and Yeovil District Hospital, says: 

“In acquired nystagmus, community optometrists would often be the first port of call.” 

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