How is congenital nystagmus treated?

Updated: Oct 08, 2019
  • Author: Mark Ventocilla, OD, FAAO; Chief Editor: Edsel Ing, MD, MPH, FRCSC  more...
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Answer

The treatment of these patients should begin with correction of any refractive error. Amblyopia should be addressed as well.

Contact lens wear has been noted to diminish infantile nystagmus, presumably by a trigeminal efferent pathway. This may also increase foveation time by avoiding induced spectacle distortion with ocular movement in patients with high degrees of ametropia.

Refractive errors, even low plus, should be prescribed, as this has been shown to improve visual acuity. An optical system with high plus spectacles and high minus contact lenses has also been shown to improve visual acuity in some patients.

Base-out prisms (eg,7 prism diopters) may be combined with -1.00 D myopic overcorrection for convergence damping in patients with binocular vision. [3]

Pharmacologically useful agents for patients with nystagmus are primarily GABA agonists or inhibitors of the excitatory neurotransmitter system. The only drug found to be of benefit in adult patients with a history of idiopathic infantile nystagmus is baclofen. This drug has not been approved for use in children. Baclofen has been effective in treating the periodic alternating nystagmus (PAN) subtype.

Recent case reports have shown gabapentin to be beneficial in congenital nystagmus, with an improvement in foveation time and vision and a decrease in amplitude and frequency of the nystagmus.

McLean et al investigated treatment of congenital nystagmus with memantine or gabapentin in a randomized, double-blind, placebo-controlled trial of 48 patients. [7] Improvement in mean visual acuity was noted in both treatment groups (F=6.2; p=0.004, analysis of variance). Patients with afferent visual defects showed poorer improvements in visual acuity to medication than those with apparently normal visual systems. However, nystagmus intensity (F=7.7; p=0.001) and foveation (F=8.7; p=0.0007) improved in both nystagmus forms as shown on eye movement recordings. Patients in both treatment groups reported vision improvement more often than patients in the placebo group (p=0.03). McLean et al concluded that memantine and gabapentin can improve visual acuity, reduce nystagmus intensity, and improve foveation in congenital nystagmus.

More study is needed to determine the role of oral and topical carbonic anhydrase inhibitors. [3]

Alternative measures, such as biofeedback, acupuncture, or cutaneous head and neck stimulation, have been reported to decrease nystagmus in select (adult) patients with a history of infantile nystagmus.


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