title: Treatment of nystagmus.
abstract: Patients with congenital and acquired forms of nystagmus are commonly encountered in clinical practice. Many report visual symptoms, such as oscillopsia and blurred vision, which can be alleviated if the nystagmus can be suppressed. Pharmacologic, optical, and surgical treatments are available, with the choice of treatment depending on the characteristics of the nystagmus and the severity of the associated visual symptoms. Downbeat nystagmus can be treated with 4-aminopyridine, 3,4-diaminopyridine, or clonazepam. Upbeat nystagmus can be reduced with memantine, 4-aminopyridine, or baclofen. Torsional nystagmus may respond to gabapentin. Acquired pendular nystagmus in patients with multiple sclerosis is often partially suppressed by gabapentin or memantine. Acquired pendular nystagmus in patients with oculopalatal tremor can respond to gabapentin, memantine, or trihexyphenidyl. Although acquired periodic alternating nystagmus is often completely suppressed by baclofen, memantine can be effective in refractory cases. Seesaw nystagmus can be reduced with alcohol, clonazepam, or memantine. Infantile nystagmus may not cause significant visual symptoms if "foveation periods" are well developed, but the nystagmus can be treated in symptomatic patients with gabapentin, memantine, acetazolamide, topical brinzolamide, contact lenses, or base-out prisms to induce convergence. Several surgical therapies have also been reported to improve infantile nystagmus syndrome (INS), but selection of the appropriate therapy requires preoperative evaluation of visual acuity and nystagmus intensity in different gaze positions. Other treatment options for nystagmus include botulinum toxin injections into the extraocular muscles or retrobulbar space. Electro-optical devices are currently being developed, in order to noninvasively negate the visual consequences of nystagmus.
authors.affiliation: Department of Ophthalmology & Visual Sciences, University of Iowa, 200 Hawkins Dr PFP, Iowa City, IA, 52242, USA, mj.thurtell@gmail.com.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Thurtell
authors.forename: R John
authors.initials: RJ
authors.lastname: Leigh
references.citation: Clin Neuropharmacol. 2009 Mar-Apr;32(2):109-10
references.pmid: 19512963
references.citation: Neurology. 2009 May 12;72(19):1630-3
references.pmid: 19092106
references.citation: Brain. 2007 Sep;130(Pt 9):2441-51
references.pmid: 17664175
references.citation: J Neurol. 1997 Jan;244(1):9-16
references.pmid: 9007739
references.citation: Binocul Vis Strabismus Q. 2007;22(4):235-41
references.pmid: 18163900
references.citation: J AAPOS. 2004 Dec;8(6):539-48
references.pmid: 15616501
references.citation: Mov Disord. 1987;2(2):93-8
references.pmid: 3504267
references.citation: Open Ophthalmol J. 2010 Jul 29;4:42-51
references.pmid: 21270949
references.citation: Neurology. 2003 Jul 22;61(2):165-70
references.pmid: 12874393
references.citation: Binocul Vis Strabismus Q. 2000;15(1):53-8
references.pmid: 10767683
references.citation: Ann Neurol. 1992 Nov;32(5):633-42
references.pmid: 1449243
references.citation: Neurology. 2000 Jun 13;54(11):2190-1
references.pmid: 10851400
references.citation: Ann Neurol. 2010 May;67(5):676-80
references.pmid: 20437565
references.citation: Ann Neurol. 1997 Jun;41(6):818-25
references.pmid: 9189045
references.citation: Invest Ophthalmol Vis Sci. 2009 Nov;50(11):5201-6
references.pmid: 19458336
references.citation: Ann Neurol. 2007 Feb;61(2):130-8
references.pmid: 17279539
references.citation: J Neuroophthalmol. 2010 Dec;30(4):361-71
references.pmid: 21107124
references.citation: Invest Ophthalmol Vis Sci. 2006 Jun;47(6):2451-60
references.pmid: 16723456
references.citation: J Neurol. 2010 Mar;257(3):322-7
references.pmid: 19756822
references.citation: J Neurol. 2011 Jul;258(7):1207-22
references.pmid: 21461686
references.citation: Neurology. 2010 Nov 23;75(21):1928-32
references.pmid: 21098408
references.citation: Neurology. 1987 May;37(5):887
references.pmid: 3619996
references.citation: Strabismus. 2008 Jan-Mar;16(1):29-32
references.pmid: 18306120
references.citation: J Neurol Neurosurg Psychiatry. 1991 Jul;54(7):627-32
references.pmid: 1654396
references.citation: J AAPOS. 2006 Aug;10(4):312-7
references.pmid: 16935229
references.citation: Ann Neurol. 1980 Dec;8(6):609-11
references.pmid: 7212648
references.citation: Am J Ophthalmol. 1988 Nov 15;106(5):584-6
references.pmid: 3189473
references.citation: Laryngoscope. 2001 Aug;111(8):1490-3
references.pmid: 11568589
references.citation: J Neuroophthalmol. 2011 Sep;31(3):228-33
references.pmid: 21709585
references.citation: J Neurol Neurosurg Psychiatry. 2005 Mar;76(3):451-3
references.pmid: 15716550
references.citation: Neurology. 1978 Dec;28(12):1259-64
references.pmid: 366453
references.citation: Ophthalmology. 1986 Jul;93(7):924-32
references.pmid: 3763138
references.citation: Neurology. 2004 May 11;62(9):1623-5
references.pmid: 15136697
references.citation: Neurology. 1986 Jan;36(1):82-4
references.pmid: 3941789
references.citation: Am J Ophthalmol. 1995 Apr;119(4):489-96
references.pmid: 7709974
references.citation: Rev Neurol (Paris). 1995 Jan;151(1):60-2
references.pmid: 7676133
references.citation: Handb Clin Neurol. 2011;102:333-78
references.pmid: 21601073
references.citation: Neurology. 1986 Jun;36(6):841-4
references.pmid: 3703293