MANAGEMENT OF NYSTAGMUS

C. Polo MD 1 , J. Cena MD 2
1 Hospital Piñero, Buenos Aires (Argentina)
2 Hospital Vilela, Rosario (Argentina)
 Nystagmus is defined as an involuntary rhythmic oscillation of the eyes.

 Nystagmus in Albinism is an Infantile nystagmus, which usually appears in the first 3e6 months of life, leads to reduced visual acuity due to the excessive motion of images
on the retina, and also the movement of images away from the fovea. The characteristics of Nystagmus in albinism are variable in each patient.

 The therapeutic alternatives we have are: carbonic anhydrase inhibitors in drops to minimize it. Other options are the use of contact lenses and surgery to improve
torticollis or minimize its frequency.

 In this poster we present three cases where these treatments were used.

CASE 1 CASE 2 CASE 3

NYSTAGMUS AND STRABISMUS TREATMENT WITH TOPICAL CONTACT LENS
SURGERY BRINZOLAMIDE

PREOPERATORY: Visual acuity : 20/200 BE

Patient with esotropia and nystagmus Visual acuity :LE 20/100 RE 20/70 Pendular Nystagmus
Visual acuity : 20/100 BE Pendular Nystagmus
Pendular Nystagmus

POSTOPERATORY
Visual acuity : 20/70 BE
Ortotropia
Plsusoptix: Improvement of fixation and
stabilization of nystagmus.

After 1 year with topic Brinzolamide:

Visual Acuity 20/50 Visual acuity : 20/100 BE with Contact Lens with
Improvement of quality vision and fixation astigmatism correction and iris print

Pendular Nystagmus with minimal improvement

CONCLUSION: The treatment of nystagmus in Albinism has as its main objective improve both visual acuity, increasing stability in fixation, such as
compensatory torticollis in the case of exists and the aesthetic aspect of the nystagmus, decreasing its intensity.
The first therapeutic step in the treatment of patients with nystagmus is to correct the refractive error with glasses or contact lenses, since these
patients present typically a high astigmatism in favor of the rule. I know can add prisms to improve head posture and, in cases where the
nystagmus decreases with convergence, it might be indicated to add ˜ base prisms temporary to stimulate convergence. In any casegood
response to prisms is a good indicator of the response to surgery.
Among the indications for surgical treatment are find: torticollis, since these patients present a nystagmus block with gaze and strabismus; and
improvement of nystagmus with convergence. The most commonly surgical techniques used are retroinsertion, resection, and tenotomy, or a
combination thereof. The retroinsertion of the muscles that have their action in the direction of the torticollis aim to move the eyes in that
direction, bringing the eyes to the locked position in primary position, thus improving the abnormal posture of the head.
Other authors propose a retroinsertion of the 4 horizontal muscles behind the equator to decrease the torsional effect of the muscles .
Tenotomy could also be an option therapeutic in these patients, since it could interrupt the proprioceptive circuit present in the nerve endings
of the tendinoscleral junction, which would lead to a decreased response to the nystagmus signal.
Regarding medical treatment, multiple options have been proposed over the years with different results, among which we can highlight the
botulinum toxin and the carbonic anhydrase inhibitors (Brinzolamide).
The effect of anhydrase inhibitors carbonica is based on the same principles as tenotomy, that is, blocking the proprioceptive circuit of the
junction tendon-sclera. Previous studies show that this effect It is obtained both by administering them orally and by route topical.

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