Medical treatments for abnormal eye movements: pharmacological, optical and immunological strategies.
OBJECTIVE
To review current medical treatments for nystagmus and saccadic intrusions, and their visual consequences.


METHODS
Evaluation of studies that have used reliable measurement of eye movements and visual acuity before and after treatment. Interpretation of results in light of physiological and pharmacological studies in animals, and recent immunological advances.


RESULTS
There are many case reports of patients with abnormal eye movements being improved by a variety of drugs, but few double-blind, controlled studies have been carried out. Most promising are agents that mediate their effects through the neurotransmitter gamma-aminobutyric acid; such drugs include baclofen and gabapentin. Botulinum toxin, injected into selected extraocular muscles or the retrobulbar space, can abolish nystagmus for several months, but often produces troublesome side-effects, such as diplopia and ptosis, which limit its value. Optical measures to either reduce nystagmus by manipulating vergence angle, or reduce retinal image motion, help some patients. Opsoclonus occurring in association with cancer may be successfully treated with an immuno-adsorption technique using a protein A column.


CONCLUSIONS
There is need for controlled, blinded studies to evaluate the many agents reported to improve visual symptoms in individual patients with abnormal eye movements.
Averbuch-Heller
L
L
Department of Neurology, Veterans Affairs Medical Center, Cleveland, Ohio, USA.
Leigh
R J
RJ
D000818:Animals; D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use*; D001905:Botulinum Toxins / Q000627:therapeutic use*; D005139:Eyeglasses; D018755:GABA Agonists / Q000627:therapeutic use*; D006801:Humans; D007167:Immunotherapy; D009759:Nystagmus, Pathologic / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D012438:Saccades; D016896:Treatment Outcome
D018726:Anti-Dyskinesia Agents; D018755:GABA Agonists; D001905:Botulinum Toxins