What is the role of surgery in the treatment 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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  • Removing the inciting etiology if possible (eg, intracranial tumors, ocular media opacities)

  • Botulinum toxin may be used to treat patients with acquired nystagmus to dampen the nystagmus and to improve visual acuity and to decrease oscillopsia.

    • The toxin may be injected into the rectus muscles (2.5 U per muscle) or may be given as a retrobulbar injection [17] (10-25 U in 0.1-1 cm3).

    • Multiple injections usually are necessary as the effect of the toxin wears off.

    • Patients whose symptoms improve with botulinum toxin injection may be able to discern when the effect of the toxin begins to diminish as the symptoms may begin to recur.

    • A disadvantage of this treatment option is that botulinum toxin impairs all types of eye movement (eg, saccades, smooth pursuit).

    • Complications of toxin injection include ptosis, diplopia, increase of nystagmus in the noninjected eye, and, rarely, globe rupture.

  • Extraocular muscle surgery for correction of nystagmus is based on surgically shifting the null zone into primary position. Again, null zones are more characteristic of congenital nystagmus; thus, they may not be applicable to most forms of acquired nystagmus. Retroequatorial rectus muscle recessions have been shown to be effective in treating acquired nystagmus without a null point, [18]  as has extraocular muscle tenotomies with reattachment. [19]

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