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- slow+fast phases or pendular
- hoz with small torsional
- increased intensity with fixation
- decreased intensity with inattention/sleep
- variable intensity in DFOG
- head oscillations
- full rx and if ortho - 7BO yoked prism
- if strab present - then prism to correct- usually if sensory fusion improves, nystagmus will decrease
- direction of fast phase
- movement intensity
- gaze and convergence effects
- dx vs near
Clinical assessment of nystagmus?
- always take bino VA
- full cyclo in kids
- ret - ignore oscillation, do in null position, older kids
- binocular rx - can fog oscillating eye
treatment for congenital nystagmus
give full rx - will improve visual acuity and function
Common sx of nystagmus?
- decreased VA
What is the difference between pendular and jerk nystagmus?
- pendular: no change in velocity in diff directions
- jerk: fast and slow phases have unequal velocity
Acquired vs congenital jerk velocities of slow phases?
- acquired: linear or decreasing velocity
- congenital: increasing velocity
- nystagmus present only in eccentric, hoz gazes
- amp is small
- very fast velocity
- nystag extinguishes with time
- resolves when eye is moved to less eccentric position
Gaze evoked nystagmus?
- Cause: medication
- Not central
- beats in direction of eccentric gaze
Nystagmus due to VL?
- Cause: fixation disruption
- Jerk: retinal
- Pendular: ON
- Tx: underlying cause
- Cause: MS/CNS demyelination
- Tx: gabapentin
Nystagmus due to vestibular imbalance?
- Follows Alex's Law: nystagmus increases in direction of fast phases
- Tx: Meds
- Acute: Spontaneous recovery
Periodic alternating nystagmus?
- Cause: lesion
- hoz jerk nystagmus spontaneously recerses direction every 60-90s
- DDX: peripheral vestibular ynstagmus
- cause: due to intracranial neoplasm
- head nodding + nystagmus
- refer children for neuro + head scan