If you or a loved one has been diagnosed with nystagmus, read on. Understanding the condition is the first step toward effective management and care. This guide provides everything you need to know about nystagmus, including its causes, symptoms, types, treatments, and living with the condition.
What is Nystagmus?
Nystagmus is a condition where the eyes move uncontrollably, often in a rhythmic repetitive pattern.
The movements are involuntary and can make it challenging to focus on objects. Depending on the type, nystagmus can be present at birth, develop later in life, or be triggered by other health issues. Involuntary movements may be horizontal, vertical, or circular and can vary in speed and intensity.
Symptoms of Nystagmus
The most common nystagmus symptoms are:
Uncontrolled eye movements (side-to-side, up-and-down, or rotary pattern)
Difficulty focusing on objects
Dizziness or balance issues
Sensitivity to light
Blurry or unstable vision, especially during movement
A head tilts or turns to find a position where vision is clearer (null point)
Nystagmus symptoms vary according to the type and severity of the condition and whether it’s congenital or acquired. We will cover the types of nystagmus and why they occur later in this article.
Nystagmus Causes
Nystagmus causes may be genetic factors, neurological conditions, inner ear disorders, head trauma, severe nearsightedness, or cataracts. In mild cases, nystagmus may occur temporarily due to vitamin B12 deficiency or as a reaction/side effect of medications and substances.
1. Genetic Factors
Congenital nystagmus is often inherited and appears in infancy. We associate it with:
Albinism
Idiopathic Infantile Nystagmus Syndrome (IINS)
Leber’s Congenital Amaurosis (LCA)
Albinism is a genetic condition affecting melanin production that can alter retinal development and optic nerve connections, leading to nystagmus. In IINS, nystagmus occurs without other significant eye or neurological problems. LCA is a rare inherited disorder with severe vision impairment, often alongside nystagmus.
RELATED: Which Eye Conditions are Hereditary?
2. Head Trauma
Injuries to the head can damage the brain, brainstem, or inner ear, resulting in nystagmus. Eye movement problems from a head trauma occur due to:
Concussions or traumatic brain injuries (TBI)
Fractures to the skull or temporal bone
Whiplash injuries
Brain injuries and concussions affect the vestibular system, while skull and temporal bone fractures disrupt inner ear function. As for whiplash injuries, they affect the cervical spine and brainstem, sometimes causing involuntary movements of the eyes.
3. Inner Ear Disorders
The inner ear controls balance and spatial orientation. Any disruptions can trigger nystagmus:
Vestibular Neuritis/Labyrinthitis
Ménière’s Disease
Benign Paroxysmal Positional Vertigo (BPPV)
Vestibular neuritis or labyrinthitis is an inner ear inflammation that causes vertigo, dizziness, and nystagmus. Excess fluid buildup in the inner ear from Ménière’s disease can present as tinnitus and involuntary eye movements. Brief episodes of nystagmus when changing head positions is a trait of displaced otolith crystals in the inner ear or BPPV.
4. Neurological Conditions
Neurological disorders can cause nystagmus by disrupting the brain regions responsible for eye movement control, including the cerebellum, brainstem, and vestibular system. Examples include:
Multiple Sclerosis (MS)
Stroke
Brain Tumors
Neurodegenerative Diseases
Damage to the myelin sheath due to multiple sclerosis can damage nerve signals controlling eye movement. A cerebrovascular event like a stroke affects the brainstem or cerebellum and may result in oscillatory nystagmus.
Brain tumor lesions in the posterior fossa or brainstem may impact eye movement control centers, as well. Last but not least, diseases like ataxia and Parkinson’s disease affect motor control and patients often report nystagmus symptoms.
RELATED: Eye Damage After Stroke
5. Severe Nearsightedness (High Myopia)
Extreme myopia may trigger structural changes in the eye like retina stretching or thinning, and cause:
Foveal instability
Retinal detachment
Degenerative changes in the retina
Foveal instability due to high myopia leads to small, involuntary eye movements resembling nystagmus. Retinal detachment and degenerative changes may impact visual processing and contribute to uncontrollable movement of the eyes.
6. Cataracts
Significant lens opacities, particularly in childhood, can impair visual development and lead to sensory deprivation nystagmus. This occurs when the brain fails to receive clear visual input during early development, affecting the stability of eye movements.
7. Vitamin B12 Deficiency
Vitamin B12 helps nerve function. Its deficiency may show as neurological symptoms like nystagmus. The deficiency may result from:
Pernicious anemia (an autoimmune condition affecting B12 absorption)
Chronic malnutrition
8. Medications and Substances
Side effects of certain drugs and substances may disrupt the normal functioning of the nervous system and vestibular system. These disruptions may present as nystagmus:
Anti-seizure medications (e.g., phenytoin, carbamazepine)
Sedatives and tranquilizers (e.g., benzodiazepines, barbiturates)
Recreational drugs (e.g., phencyclidine, ketamine, or hallucinogens)
Alcohol intoxication
RELATED: The Effect of Alcohol on Vision
Types of Nystagmus Based on Cause
Congenital Nystagmus (Infantile Nystagmus)
Congenital nystagmus appears in infancy, usually within the first six months of life. Most commonly it is horizontal and does not change direction. The severity may lessen as the child grows. The cause is often associated with genetic or chronic conditions, albinism, or visual impairments like congenital cataracts.
Acquired Nystagmus
Acquired nystagmus develops later in life due to underlying medical issues. It can be horizontal, vertical, or rotary and may worsen with certain activities or positions. Neurological disorders (e.g., multiple sclerosis, stroke), head injuries, or drug and alcohol intoxication are the most common causes of acquired nystagmus.
Vestibular Nystagmus
This type of nystagmus is linked to inner ear or balance system issues. The condition often occurs with vertigo and balance problems. Conditions like Meniere’s disease or vestibular neuritis can trigger vestibular nystagmus.
Latent Nystagmus
Latent nystagmus is typically only apparent when one eye is covered. A notable characteristic is that eye movements increase when one eye lacks stimulation. The condition stems from amblyopia (lazy eye) or strabismus.
Types of Nystagmus Based on Eye Movement Direction
Horizontal Nystagmus
This type refers to involuntary eye movements that occur side-to-side, along the horizontal plane. It's one of the most common forms of nystagmus and is often seen in conditions like vestibular disorders, neurological diseases, or as a medication response.
Horizontal nystagmus can be further classified into left-beating (eyes drift to the right and jerk back to the left) or right-beating (eyes drift to the left and jerk back to the right).
Vertical Nystagmus
In vertical nystagmus, the eyes move up and down. This type is less common and often points to a central nervous system issue, such as brainstem or cerebellar lesions.
Vertical nystagmus can be upbeat (eyes drift down and jerk upwards) or downbeat (eyes drift up and jerk downwards), with downbeat nystagmus being a hallmark of specific neurological disorders.
Rotary Nystagmus
Rotary nystagmus, a.k.a. circular or torsional nystagmus, is when the eyes rotate around the visual axis. It occurs with vestibular dysfunction or inner ear disturbances, such as BPPV (Benign Paroxysmal Positional Vertigo).
Nystagmus with a torsional component is frequently observed along with other types of nystagmus.
Types of Nystagmus Based on Movement Characteristics
Pendular Nystagmus
Pendular nystagmus is about smooth, sinusoidal eye movements of equal velocity in both directions, without a distinct fast or slow phase. The oscillations may occur horizontally, vertically, torsionally, or in combination. Pendular nystagmus has equal velocity in both directions, often bilateral (occurs in both eyes).
This form of nystagmus is frequently associated with neurological disorders affecting the afferent visual pathways, particularly in congenital visual impairment (e.g., albinism, Leber's congenital amaurosis) or central nervous system pathologies such as multiple sclerosis and brainstem lesions.
Jerky Nystagmus
In contrast, jerky nystagmus (also termed "saccadic nystagmus" or "asymmetric nystagmus") is about unequal eye movement. It consists of two distinct phases:
Slow drift of the eyes in one direction due to an underlying vestibular or neural imbalance
Rapid fast phase in the opposite direction, which serves as a compensatory mechanism
Eye doctors associate this pattern with vestibular dysfunction, cerebellar disorders, or brainstem lesions. For instance - vestibular neuritis, Ménière’s disease, and central nervous system disorders such as stroke or multiple sclerosis.
Gaze-Evoked Nystagmus (GEN)
Gaze-evoked nystagmus is a sub-type of jerky nystagmus. It occurs when the eyes move to an eccentric (non-primary) position and fail to maintain fixation. GEN differs from other types of nystagmus because it appears only when looking to the side or in another specific direction.
GEN causes include impaired neural control of gaze holding due to brainstem, cerebellum, or vestibular system dysfunction. It is one of the most common types of nystagmus observed in clinical settings and can be reduced with fixation, unlike congenital nystagmus.
Nystagmus Diagnosis
In most cases, diagnosing nystagmus involves:
Full eye exam
Neurological evaluation
Imaging tests
Vestibular testing
Blood tests
During the eye exam, the doctor will check visual acuity, eye movements, and overall eye health. The patient should also see a neurologist to rule out brain or nervous system issues. MRI or CT scans can detect potential brain abnormalities.
For a thorough examination, we also recommend vestibular testing and blood tests. They help determine if the issue is related to the inner ear or if there are any deficiencies or health conditions you don't know about.
Treatment Options for Nystagmus
No universal cure for nystagmus has been found yet.
Various treatments can manage symptoms and improve quality of life.
Assistive devices
Medications
Eye muscle surgery
Treating other conditions
Correcting refractive errors with glasses or lenses can help with vision stability. Magnifiers, screen readers, or text-to-speech tools can aid those with significant visual impairment, even though they don't cure nystagmus.
Certain drugs, like gabapentin or memantine, may reduce nystagmus intensity in some cases. Surgical procedures like tenotomy can reposition eye muscles to improve the null point and reduce head tilting.
Addressing chronic diseases, neurological disorders or inner ear issues can alleviate nystagmus symptoms.
Living With Nystagmus
Living with nystagmus comes with visual perception challenges.
The constant movement of the eyes can make it hard to focus on objects, so blurry or unstable vision is quite common. Judging distances can also be difficult, affecting tasks like walking on uneven ground or catching objects. When following moving objects or reading lines of text, the eyes may struggle to maintain a steady gaze.
Tasks requiring fine focus, like reading or writing, may take longer. People with nystagmus may have to use a finger to track text or rely on magnification tools.
In some nystagmus cases, driving may not be possible due to the reduced reaction time to visual cues. Maintaining eye contact tends to be tricky, leading to misunderstandings or discomfort in social situations.
The effort to focus on objects or compensate for eye movements can cause headaches or tired eyes. Some people may perceive their environment as continuously moving (oscillopsia), which can be disorienting.
From a social aspect, visible eye movements can draw unwanted attention, potentially causing embarrassment or discomfort in public settings. Many individuals develop creative strategies to adapt to their visual challenges, building resilience and problem-solving skills.
Coping Strategies
Managing nystagmus depends on more than medical treatments.
Some habits to make daily life easier are:
Lighting adjustments
Head positioning
Support groups
Adjusting lighting conditions can reduce glare and improve visual clarity. Bright, glare-free environments make focusing easier. A specific head tilt (null point) can suppress eye movements and improve vision clarity.
Connecting with others who have nystagmus can provide emotional support and practical advice. If you have nystagmus, inform employers, teachers, or friends about your condition to foster understanding and accommodations.
The outlook for nystagmus depends on its type and root cause. While congenital nystagmus often stabilizes and doesn’t worsen, acquired nystagmus may need ongoing treatment and monitoring, more so with a neurological condition. With proper care and adaptive strategies, many individuals with nystagmus lead full, active lives.
Questions About Nystagmus
Can nystagmus go away on its own?
Congenital nystagmus does not resolve but may improve with age. Acquired nystagmus might disappear upon treatment of the cause.
Is nystagmus hereditary?
Are there any lifestyle changes that help coping?
Can stress make nystagmus worse?
Yes, stress, fatigue, or anxiety can exacerbate symptoms.
Is there voluntary nystagmus?
In Summary...
Many people with nystagmus lead fulfilling lives by adapting their routines and using technology or professional help. While the condition poses challenges, it also fosters creativity, adaptability, and resilience.
External resources:
✅ Medically reviewed
Checked by Atanas Bogoev, MD.