Nystagmus: Presenting in Infancy PDF

NYSTAGMUS PRESENTING IN INFANCY 98  NYSTAGMUS Definition: Involuntary, rhythmic oscillation of the eyes Disrupts steady fixation Affects visual acuity -completely normal eye b...

NYSTAGMUS PRESENTING IN INFANCY 98  NYSTAGMUS Definition: Involuntary, rhythmic oscillation of the eyes Disrupts steady fixation Affects visual acuity -completely normal eye but it’s never not moving so vision won’t be good in that eye 99  1. Direction – direction of fast phase Plane – horizontal, 2. vertical, cyclorotary Amplitude – size of oscillation 3. Frequency – cycles per second 4. Intensity – amplitude x frequency NYSTAGMUS 5. Waveform – jerk, pendular, complex 6. Conjugacy – conjugate/associated vs. CHARACTERISTICS 7. disconjugate/dissociated Null point – position of gaze in which nystagmus intensity 8. is at a minimum and foveation is maximal, leads to compensatory head posture Foveation – eye movements are slow enough to allow 9. “foveation” and good acuity 100  NYSTAGMUS Congenital Motor Nystagmus (Idiopathic Infantile Nystagmus) Onset within the first 6 months of life Usually sporadic, can be autosomal dominant Typically, purely horizontal in all positions of gaze Vision quite good, no oscillopsia Pendular or jerk waveform Dampens with convergence Null point common, so may have compensatory head turn VA 20/40 to 20/80 à depending on intensity and frequency MUST RULE OUT PATHOLOGIC CAUSES -if someone has acquired nystagmus then they will have nystagmus 101 FUNBLOCS – CONGENITAL Fixation – worsens NYSTAGMUS Upgaze – remains horizontal Null point à subtle head movement Bilateral and conjugate à eyes are moving together Latent component OKN reversed Convergence dampens nystagmus à Do NPC Symptomless 102  Latent Nystagmus Jerk nystagmus found in patients with congenital esotropia, early developmental vision loss, and Down syndrome that is more apparent when one eye is occluded Sensory Nystagmus TYPES OF Due to poor vision (usually worse than 20/200) Often pendular, but can be jerk Causes include cataracts, NYSTAGMUS corneal opacity, chorioretinal coloboma, ROP, aniridia, ON hypoplasia, albinism, cone dysfunction, achromatopsia, CSNB, Leber’s Neurologic/Pathologic Nystagmus Any child with acquired nystagmus should receive neurologic evaluatio n oscillopsia (+) 103 CAUSES OF SENSORY NYSTAGMUS Congenital cataracts Corneal opacity Aniridia Albinism Leber’s congenital amaurosis Optic atrophy Achromatopsia Foveal hypoplasia ROP Chorioretinal coloboma Congenital macular scar (toxo) Optic nerve hypoplasia Optic nerve coloboma 104 TYPES OF NYSTAGMUS Spasmus Nutans Onset after 6 months of age Decreases or disappears by age 4-5 Pendular nystagmus with associated head nodding and torticollis Disconjugate, can appear monocular Low amplitude, high frequency, “shimmering” Benign, but MUST RULE OUT ALL PATHOLOGIC CAUSES 105 SPASMUS NUTANS https://www.aao.org/disease- review/neuro-ophthalmology- spasm us-nutans https://www.youtube.com/watch?v= ljnwpW1Ul10 106 NYSTAGMUS TREATMENT Optical Treatment Surgical Treatment Pharmacological BO prism – if convergence Anderson-Kestenbaum procedure Botulinum toxin dampens nystagmus significantly Cuppers artificial divergence Yoked prism for eccentric null procedure point Large recessions of the horizontal rectus muscles Contact Hertle-Del’Osso procedure lenses 107 PEDIATRIC OCULAR It’s that simple! DISEASE 108