Nystagmus (colloquially "eye tremor") is a common eye disorder in which both eyes tremble or twitch uncontrollably. Eye tremor can occur in various forms and is manifested by flapping or oscillating movements of the eye. Nystagmus is often accompanied by dizziness and can be a sign of neurological disorders.
Below you will find further information and selected nystagmus specialists.
Nystagmus is one of the most common conditions in ophthalmology. The word nystagmus comes from the ancient Greek and means nodding.
Nystagmus is very unpleasant for patients as the eye tremors occur uncontrollably. As other people also notice it, it is a major psychological burden for those affected.
The eye tremor typically occurs on the same side and at the same time. These uncontrolled movements are referred to as conjugate (=simultaneous): If the right eyeball moves to the right side, the left eyeball also follows to the right side. If the left eyeball moves to the left side, the right eyeball also moves to the left side.
There are many different forms of nystagmus, which experts differentiate from one another based on various criteria.
What all forms have in common is that the nystagmus consists of a slow and a fast movement. This is how the typical eye tremor occurs.
Eye tremor can occur in various forms:
One way of classifying specific nystagmus is, for example, the time at which the eye tremor occurs. This differentiates:
Further classifications are made according to the form and direction of the beat and the cause and triggering of the eye tremor:
Doctors also generally differentiate between the following types of eye tremor:
Physiological
The physiological form of nystagmus is an occurrence of nystagmus without negative effects on the organism. In this case, the nystagmus serves the natural adaptation of the eyes to the environment or to compensate for the movement of the body.
Nystagmus is necessary so that the patient can see sharp images when looking out of a moving train, for example. Experts also call this form optokinetic nystagmus. This allows the image projected through the lens to remain as constant as possible on the retina.
Examples of physiological nystagmus are
Optokinetic nystagmus
Pathological
Pathological forms of nystagmus belong to the family of so-called supranuclear eye movement disorders. They should definitely be treated by a neurologist or ENT specialist if they do not occur only temporarily or once.
Nystagmus also occurs temporarily as a side effect of some addictive substances (e.g. ecstasy). This nystagmus is then a result of a lack of coordination between the sense of balance and vision.
Other forms of nystagmus that occur continuously can indicate neurological diseases. For example, the brain stem or cerebellum may be pathologically different. Diseases of the vestibular system are also sometimes accompanied by nystagmus.
If eye tremors persist, you should always consult a specialist.
The following forms of pathological nystagmus exist:
First, the doctor and patient discuss the patient ' s medical history and clarify any previous illnesses or family history.
This information is important so that the doctor can differentiate between a congenital or acquired form.
During this consultation, the doctor will ask you to describe the eye tremor in detail. He will ask you a few questions so that he can classify the nystagmus accurately.
He will also ask you to assume different head positions. You then describe how the visual acuity or eye tremor changes.
The following diagnostic methods can be used to diagnose nystagmus:
An examination with Frenzel spectacles has proved very successful in recent years. The patient puts on the Frenzel spectacles like conventional glasses. However, they are slightly larger and heavier.
Doctors use Fenzel spectacles as an examination method to diagnose spontaneous nystagmus. The special lenses of the Frenzel glasses enlarge the eyes on the one hand and prevent sharp perception on the other. If the patient wears the glasses, they cannot see any objects in the room clearly.
This enables error-free diagnostics as the patient is not distracted. Doctors usually carry out the examination in a darkened room. The LEDs inside the glasses allow the doctor to observe the eye tremors precisely.
Frenzel glasses
Electronystagmography (abbreviated to ENG) is another imaging method used to examine nystagmus. Here, the doctor applies electrodes to the forehead, under the eyes and in the nose area of the patient. These record the eye tremors electrically.
The electrodes can be easily attached using adhesive surfaces. The patient can remove them painlessly after the examination.
Potential side effects of this examination method include nausea, vomiting and dizziness.
As in any medical field, the doctor's diagnosis is crucial. The treatment of nystagmus depends on the specific type, severity, cause of the eye tremor and the compensatory methods available.
For example, the patient can compensate for and mitigate eye tremor by changing the position of the head. The primary aim of treatment is to improve the patient's visual acuity. There are numerous treatment methods for this.
When treating nystagmus with medication, the doctor will preferably prescribe memantine or gabapentin.
Doctors usually use memantine in Europe and the United States to treat dementia.
The preparation is also used in Parkinson's therapy. Side effects of memantine include headaches, nausea, dizziness, fatigue, vomiting and confusion.
Doctors usegabapentin to treat pain within the peripheral nervous system or epilepsy. It is important that the patient does not consume alcohol or morphine, as this can lead to severe undesirable side effects.
The opinion of experts on the medical treatment of nystagmus is rather controversial. Some researchers and doctors doubt the effectiveness of these preparations for treating eye tremors.
Surgical treatment, on the other hand, is much more common and is used for some forms.
In around 50% of patients, doctors can reduce congenital nystagmus with surgical measures. Experts use special preliminary examinations to determine the appropriate surgical principle.
It must be clarified whether the patient shows less eye tremor with a certain head position and whether there is a forced head position.
Doctors must also determine whether the patient is better able to recognize objects close up or at a distance. Based on this knowledge, the specialist can choose between two common surgical procedures.
One procedure consists of reducing the severity of the nystagmus. This can be achieved, for example, through one or more eye muscle operations or an injection of botulinum toxin (Botox). Botulinum toxin is a neurotoxin with a very strong effect that has been used in medicine since the 1980s. As well as being used in cosmetic surgery to reduce wrinkles , Botox can also help as an alternative to eye muscle surgery.
However, treatment with botulinum toxin has two fundamental disadvantages:
For this reason, doctors prefer to treat nystagmus with surgery.
Botox can reduce the uncontrolled eye movements associated with nystagmus, although the results do not last long @ Oleksandr /AdobeStock
The other surgical procedure aims to strengthen the patient's compensatory mechanisms against eye tremors. The aim is to find out which compensatory measures (e.g. changed head position) the patient can use to minimize the individual eye tremor.
Some patients have less eye tremor when looking to the side. The doctor uses this effect by shifting the eyes during the operation so that the eye tremor stops when looking straight ahead. This method is also called parallel shift according to Kestenbaum.
This is how the procedure works:
Some patients, on the other hand, report less severe eye tremors when looking at close-up objects. In this case, the doctor speaks of so-called nystagmus calming by convergence.
Doctors can also treat this form of nystagmus particularly well surgically. The aim of this surgical procedure is to reduce the eye tremor that is reduced in near vision, even in distant vision.
The preferred surgical procedure is artificial divergence according to Cüppers. This involves the doctor repositioning specific outer eye muscles.
The eyes are among the most important human sensory organs. Potential complications that occur during nystagmus surgery can therefore have a major impact on the patient's quality of life.
If the operation is performed on the oblique outer eye muscles, for example, there may be more severe bleeding. This is due to the close positional relationship to a venous blood vessel (so-called vortex vein).
The surgeon should not operate on too many outer eye muscles at the same time in order to keep the supply to the eye muscles as constant as possible. For this reason, it is advisable to arrange several surgery appointments.
Cutting off several eye muscles can impair the blood supply to the front sections of the eye.
An infection of the eye can occur as a side effect of the treatment.
As a rule, however, surgical measures against eye tremors are associated with low risks. In particular, permanent damage to the eyes is very rare.
Before the operation, the patient should have a detailed discussion with the anesthetist to ensure that he or she receives a risk-free anesthetic.
If you are allergic to certain substances, you should inform the anesthetist. You should also haverealistic expectations of the operation.
You should not assume that you will be able to see much better after nystagmus surgery. However, most patients find it easier to see after the operation.
Patients usually stay in hospital for a few days after the operation. This allows the hospital staff to treat the post-operative wounds professionally.
Doctors can monitor the success of the treatment and quickly identify and treat any complications and side effects (e.g. inflammation).
Patients who opt for outpatient surgery are allowed to go home after the operation. However, they must attend the follow-up appointments.
Nystagmus is an eye disorder for which there is still no cure. Trembling of the eyes can be an indication of neurological diseases or pathological changes in the vestibular system.
At present, doctors can only reduce the severity and frequency of nystagmus. Several medical treatment methods are available for this purpose.
Surgical treatment of eye tremor is particularly common, as it is very successful and carries relatively few risks. The patient is given a general or local anesthetic during the operation.
During the operation, the doctor relocates individual outer eye muscles and surgically removes other outer eye muscles.
An alternative to surgical therapy is treatment with the neurotoxin botulinum toxin (Botox) or other medicinal preparations.
However, these are discussed rather controversially with regard to their effect and long-term success. Which treatment is right for the patient can only be clarified in a consultation with a specialist.
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