What is nystagmus, and how does it affect your vision?
Nystagmus (nih‑STAG‑mus) is a condition that causes quick, uncontrollable eye movements. These movements can make your vision look shaky or blurry. You can be born with nystagmus or develop it later in life.
Nystagmus can be caused by other eye or health problems, and it can be temporary or long-lasting. Eye doctors and other health care professionals can help treat or manage nystagmus and its effects on your vision and daily life.
How common is nystagmus?
Nystagmus is uncommon. Research suggests that about 1 in 400 people have some form of this condition.
Signs and symptoms of nystagmus
The main symptom of nystagmus is quick, rhythmic eye movements you can't control. They can happen in different ways:
- Side to side (horizontal nystagmus)
- Up and down (vertical nystagmus)
- In circles (torsional nystagmus)
These eye movements can be large and easy to see, or small and less noticeable. They usually happen in both eyes but may be more noticeable in one. Rarely, only one eye moves.
Sometimes the movements get worse when you look in one direction and get better when you look in another direction.
Other possible symptoms
The eye movements can happen with other symptoms, such as:
- Blurry vision
- Vision that looks like it's shaking or bouncing
- The need to tilt or turn your head to see better
- Dizziness
- Balance problems
- Sensitivity to light
- Problems seeing at night or in other low light
These symptoms can vary depending on the type, cause and severity of your nystagmus.
Vision in children vs. adults
When children have congenital nystagmus, their vision often looks blurry, but doesn't look shaky. This feeling continues into adulthood for those with congenital nystagmus.
Though more common in adults, acquired nystagmus can cause people of any age to feel like their vision is moving or shaking. This sensation is called oscillopsia.
Causes of nystagmus
Many different things can cause nystagmus, and sometimes more than one is involved.
Nystagmus may be related to one or more of these issues:
- Conditions that affect the nervous system (brain, spinal cord and nerves)
- Problems with the vestibular system in your inner ear (affecting your balance)
- Eye or vision problems like strabismus and amblyopia
- Injuries
- Medications, alcohol or other substances
In some cases, doctors can't find a cause. This is called idiopathic nystagmus.
Possible triggers
Certain things can trigger eye movements or make them worse in people who already have nystagmus. Some possible triggers are:
- Loud sounds
- Hyperventilating (breathing too fast)
- Shaking your head or moving it in certain ways
- Changes in pressure
- Vibrations
Types of nystagmus
The different types of nystagmus are based on the way your eyes move and the underlying cause. You can have more than one type at the same time.
These types are often arranged by:
How or when nystagmus started
- Infantile (congenital) nystagmus – Present at birth or within the first six months of life.
- Acquired nystagmus – Develops later in life. It's usually caused by another condition, an injury or certain medications.
In babies, a type of nystagmus called spasmus nutans can appear between six months and one year old. It usually goes away on its own within a few years.
What the eye movements look like
- Jerk nystagmus – The eyes move slowly in one direction and then quickly snap back. This type is often related to the inner ear or brain.
- Pendular nystagmus – The eyes move back and forth at equal speed. This is often related to eye or nervous system conditions.
- Mixed nystagmus – Eye movements change directions or don't follow the usual jerk or pendular pattern.
When the eye movements happen
- Latent nystagmus – Eye movements only happen when you cover one eye.
- Manifest nystagmus – Eye movements happen all the time.
- Manifest-latent nystagmus – Eye movements happen all the time, but get worse when one eye is covered.
How is nystagmus diagnosed?
Nystagmus can be diagnosed by eye doctors (optometrists or ophthalmologists) and other health care professionals. Your doctor may ask you about when the eye movements started, your family history, and how the movements affect your daily life.
They may also recommend certain tests to see if another condition is involved.
Eye movement testing
An eye doctor will examine your eyes and may do certain tests to see how they move. They might also record your eye movements to keep track of the speed, pattern and other details.
Vision and eye health testing
During a comprehensive eye exam, an eye doctor can also check:
- How well you can see
- The alignment of your eyes
- How healthy your eyes are inside
They may use eye drops to dilate (widen) your pupils so they can look inside your eyes more easily.
Ear or brain tests
In some cases, your doctor may examine your ears or order brain scans (such as MRI or CT scans) or other tests to find out why you have nystagmus. This can help them find inner ear or neurological problems.
The results can help your doctor recommend treatment or refer you to another specialist if needed.
Treating and managing nystagmus
Treating nystagmus depends on what's causing it and how severe it is. If you know what's causing your nystagmus, treating that problem could also help your eye movements.
Your doctor may recommend treatment or management options to help improve your symptoms and make daily activities easier. This could include:
- Prescription glasses or contact lenses – Correcting your vision with prescription glasses or contacts may improve eye movements. Refractive surgery (like LASIK) may also help some people.
- Medicine taken by mouth – Medications like gabapentin and memantine may help reduce eye movements, but they aren't effective for everyone.
- Surgery – Eye muscle surgery may improve your head posture and make eye movements less noticeable. This is mostly used for congenital nystagmus, but researchers are also exploring surgeries for acquired nystagmus.
- Physical therapy – Special exercises that target your inner ear may help with shaky vision.
- Injections – In some severe cases, treatment called botulinum toxin (Botox) can be injected into the muscles that move the eye or the area behind the eye to make vision more stable.
Living with nystagmus
Nystagmus can affect your vision and make some daily tasks harder, but doctors and other health care professionals can help you manage and adapt to these challenges.
Early diagnosis and routine checkups help adults and children get the support they need. In addition to treatment, your doctors can help you find the most effective strategies, accommodations and resources to improve your everyday life.
When to get help
Talk to an eye doctor or other medical professional as soon as possible if your eyes, or your child's eyes, move on their own. The doctor can examine your eyes and eye movements and refer you to a specialist if needed.
Frequently asked questions about nystagmus
Can nystagmus go away on its own?
It depends on the cause. Some kinds of nystagmus can go away on their own, especially certain forms in babies and children, like spasmus nutans. However, most types need to be treated or managed to help symptoms improve or, in some cases, go away.
Does nystagmus get worse over time?
Eye movements may get better or worse, depending on the cause of nystagmus. But the movements can also stay the same over time.
Does nystagmus cause blindness?
No. While nystagmus can affect your vision in different ways, it will not make you blind. However, it's important to work with doctors to rule out other conditions that could potentially cause vision loss.
Is nystagmus a disability?
Nystagmus may be considered a disability if it makes it hard to read, work, drive or do other important activities. Your doctor or health care team can help you figure out the next steps and provide paperwork for accommodations, if needed.
Can people with nystagmus drive?
Some people with milder nystagmus can legally drive if they meet the driver's license requirements where they live. However, people who have stronger eye movements or more severe symptoms may not be able to drive. Your eye doctor can help you decide whether driving is a safe option for you.
READ NEXT: Horizontal gaze nystagmus (HGN)
