What is the role of neuro-ophthalmic exam in the evaluation of acquired nystagmus?

Updated: Oct 17, 2018
  • Author: Christopher M Bardorf, MD, MS; Chief Editor: Edsel Ing, MD, MPH, FRCSC  more...
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A complete neuro-ophthalmic examination is imperative in patients with nystagmus. Aside from a complete ophthalmic examination, including visual acuity, measurement and reactivity of the pupils to light and accommodation, measurement of intraocular pressure, testing the function of extraocular muscles, and anterior and dilated posterior segment examination, other important aspects of the examination include the following:

  • Observing the nystagmus with regard to type (eg, horizontal, vertical), frequency, amplitude, direction, and conjugate/disconjugate is important. Pure vertical, pure horizontal, or pure rotary nystagmus almost always represents central vestibular dysfunction.

  • Note whether the character of the nystagmus changes in certain directions of gaze.

    • Nystagmus due to vestibular disease increases in intensity when the eyes are turned in the direction of the saccade (fast phase), ie, Alexander law.

    • A horizontal nystagmus due to peripheral vestibular imbalance remains horizontal on upward and downward gaze.

  • Note the presence or absence of head nodding or torticollis (spasmus nutans).

  • Note whether the nystagmus dampens with fixation. Fixation inhibits nystagmus and vertigo due to peripheral lesions of the vestibular system.

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