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A Clinical Approach to Abnormal Eye Movements
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Latent nystagmus, which also appears very early in life, refers to nystagmus induced by covering one eye (Video 18.13). The nystagmus takes the form of jerk nystagmus with the fast component in the direction of the uncovered eye and the slow phase of the viewing eye beating toward the nose. Therefore, it will alternate directions depending on which eye is covered. It may be associated with congenital esotropia, dissociated vertical deviation (where the eye under the cover deviates upward), or congenital nystagmus.
Ocular oscillation and visually dependent postural control in congenital nystagmus
Published in Jan-Tjeerd de Faber, 28th European Strabismological Association Meeting, 2020
G. Savino, A. Salerni, D. Colucci, M. Manzulli, F. de Rossi, A. Dickmann
Particularly significant is the difference observed when comparing the group of patients placed in a position of maximum nystagmus to the control group of patients when the Bangerter filters were applied to the latter. The postural behaviour of the two groups did not differ for any of the variables considered except for the visual afferences. In fact, in these positions of gaze, the latter are reduced in both groups of patients, but more markedly in the group of patients suffering from congenital nystagmus. Such an observation may be attributed to the conditions of reduced vision, which is presumably lower in patient with maximus nystagmus, infact the binocular visus of the control group with filter applied was similar to the mean binocular visus of the nystagmic patients in block gaze position. Nevertheless we could not exclude that also plays an important role the nystagmic ocular motion. The ocular motion, infact, causes oscillopsia and consequent attempts to compensate it.
Evaluation of Balance
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Can a nystagmus like this result from a central lesion? Yes, in particular lesions in the VIII nerve root entry zone, vestibular nuclei or cerebellum but, almost invariably, there are additional brainstem symptoms and signs. Any other nystagmus is almost certainly of central origin. These differ from a peripheral vestibular nystagmus in waveform (e.g. pendular, a quasi-sinusoidal oscillation of the eye without distinction between slow and fast phases – Figure 62.1),21 or beat plane (e.g. vertical up or downbeat or torsional nystagmus – Figure 62.3).22 A large, horizontal nystagmus in a patient with no significant vestibular or neurological symptoms should always raise the possibility of congenital nystagmus.23
GPR143 genotypic and ocular phenotypic characterisation in a Chinese cohort with ocular albinism
Published in Ophthalmic Genetics, 2021
Junwei Zhong, Bing You, Ke Xu, Xiaohui Zhang, Yue Xie, Yang Li
The 13 patients in the current study were from 12 unrelated pedigrees. All had congenital nystagmus and suffered different extents of visual impairment. Only two of them complained of photophobia. These patients had an average age at diagnosis of 21.75 ± 16.63 years (range 1–54 years) and their BCVA was between 0.05 and 0.3 (decimal notation). Slit-lamp examination revealed different extents of abnormal pigmentation of the iris, but no translucency (Figure 1c), in the patients and the obligate carriers. Comparison with a normal iris (Figure 1a,b) revealed hyperpigmentation around the pupil region of the iris of the affected patients and either a slight depigmentation in the peripheral area (Figure 1d–f) or a mild depigmentation of the entire area and atrophy of the iris or iris stroma (Figure 1g). Fundus examinations revealed that all patients had foveal hypoplasia and different extents of fundus hypopigmentation (Figure 2).Over half of the patients showed sufficient pigmentation to mask the choroidal vessels at the posterior pole and hypopigmentation in the peripheral fundus (Figure 2a,b), while the remainder presented with hypopigmentation over the entire fundus (Figure 2c,d). OCT scanning presented a typical absence of foveal depression (Figure 2e). FAF showed macular hypo-fluorescence (Figure 2f).
Congenital stationary night blindness in a patient with mild learning disability due to a compound heterozygous microdeletion of 15q13 and a missense mutation in TRPM1
Published in Ophthalmic Genetics, 2021
M. Delle Fave, M. Cordonnier, l. Vallee, C. Condroyer, C. Zeitz, I. Balikova
The patient was a girl of one-year old referred for ophthalmological examination because of congenital nystagmus and convergent strabismus. The nystagmus appeared before the fourth month of age. It was horizontal with low amplitude and present in all directions of gaze. The child had preserved ocular movements. Right esotropia of 30 diopters was noted. Cycloplegic refraction showed myopia and mild astigmatism of −5(−1/170°) and −5(−1/20°). Anterior segment examination was unremarkable. Ocular fundus showed findings compatible with the myopia. The patient was followed clinically and at the age of two years the strabismus was still present, while the nystagmus decreased. Correction was given for the myopia and alternating occlusion therapy was started. Best-corrected visual acuity was possible at the age of 6 y. and was 0,5 and 0,4 for the right and left eye, respectively. Nystagmus and convergent strabismus persisted. The anterior segment examination and ocular fundus remained normal.
Don’t Miss This! Red Flags in the Pediatric Eye Examination: Acquired Nystagmus
Published in Journal of Binocular Vision and Ocular Motility, 2019
The clinician should ask the parents about the characteristics of the nystagmus, including age of onset, change in character over time, associated head movements during visual attention, and a thorough review of systems. If nystagmus is present before 6 months of age, it is less likely to be associated with an occult neurologic process, and more likely to be ocular in origin.2 Nystagmus that has improved or damped over time is suggestive of congenital nystagmus.2 In contrast, acquired nystagmus will often get worse over time or become more prominent when the child is sick.2 The parents should be asked if they notice any abnormal head positioning. Often patients with nystagmus will have a head turn and/or tilt in order to direct their gaze towards a null position where the nystagmus is damped. Certain types of acquired nystagmus, such as spasmus nutans, can present with head bobbing or face turn.2 The clinician must inquire about a family history of nystagmus, as this is more likely in infantile cases of nystagmus.2 Another important aspect of the history is to elicit a broad review of systems (ROS). A thorough ROS is important with any new patient. In the case of a child with nystagmus, the ROS should include specific questions about headaches, malaise, nausea or vomiting, and increasing head circumference2 Any of these signs or symptoms in a child with nystagmus should raise concern and prompt further neurological evaluation.