What Is Nystagmus?
Nystagmus is characterised by uncontrolled, repetitive movements of the eyes — these can be slow, fast, horizontal, vertical or rotary. These involuntary movements affect vision, depth perception and balance, and the condition can appear from birth or develop later due to an underlying health issue.
Congenital vs Acquired Nystagmus
| Congenital | Acquired | |
|---|---|---|
| Onset | First few months of life | Any age, after normal vision was established |
| Common causes | Inherited eye conditions, developmental issues | Neurological, inner-ear or medication-related |
| Typical impact | Children often adapt with minimal vision changes | More noticeable vision disturbance |
Eye movements can also be described by their pattern: jerk nystagmus drifts slowly in one direction then jerks back; pendular nystagmus moves smoothly and equally in both directions; manifest nystagmus is present regardless of which eye is open; and latent nystagmus only appears when one eye is covered.
Common Symptoms
Causes
Congenital Causes
Genetic eye conditions (such as albinism or congenital cataracts), optic nerve hypoplasia, retinal diseases, or neurological development disorders.
Acquired Causes
Neurological disorders (multiple sclerosis, brain tumours, stroke, head injury), inner-ear problems, medication side effects, eye diseases, or vitamin B12 or thiamine deficiency.
Noticing involuntary eye movements?
An accurate diagnosis is the first step toward the right treatment plan.
Diagnosis
Comprehensive Eye Exam
Evaluates visual clarity, eye structures and movement patterns, and checks for refractive errors.
Visual Function Tests
Assesses focusing ability, object tracking and binocular coordination to detect related issues.
Neurological Assessment
Tests reflexes, muscle strength and nerve function to identify any neurological involvement.
Eye Movement Recording
Electronystagmography (ENG) or videonystagmography (VNG) measures the direction, speed and rhythm of eye movements.
Imaging Tests
MRI or CT scans can detect tumours, injuries or vascular abnormalities affecting the brain or optic nerve.
Treatment Options
Correcting Vision Problems
Glasses, contact lenses, or prism lenses to align vision and reduce abnormal head posture.
Treating the Underlying Cause
Cataract surgery, managing neurological or inner-ear disorders, or adjusting triggering medications.
Medications
Gabapentin or memantine may help reduce symptoms in certain acquired cases.
Eye Muscle Surgery
The Kestenbaum procedure shifts the 'null point' to a straight-ahead position, reducing abnormal head posture.
Vision Rehabilitation
Low-vision aids, magnifiers, large-print materials and orientation training for significant visual impairment.
Living with nystagmus
Conclusion
Congenital nystagmus typically remains stable, with most people adapting well. Acquired nystagmus may improve once the underlying condition is treated, though it can also persist — either way, early diagnosis and a tailored treatment plan significantly improve functional vision and day-to-day comfort.
Frequently Asked Questions
Yes — cases caused by medication, alcohol, or a short-term inner-ear infection may resolve once the underlying cause is addressed.
Written by
Dr Parth ShahDr Parth Shah is director and principal ophthalmologist at Clarity Eye Surgeons, with experience in strabismus and eye movement disorders, collaborating with neurologists and rehabilitation specialists as needed.
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