Nystagmus

Abnormal eye movements that caused by - Inability to maintain fixation, - Loss of the normal inhibitory influences on the eye movements control system - Loss of the normally symmetric input from one of the vestibular pathways to the ocular motor nuclei

 Jerk Nystagmus 1. a slow phase drift from the target of interest, followed by 2. a corrective saccade (fast phase) back to the target Pendular Nystagmus occurs when the back and forth slow phase movements occur without a fast phase. Saccadic Intrusions no slow phase, only fast phase

 Patients should be asked about any associated neurologic symptoms : - vertigo - ataxia - motor weakness - sensory weakness

- any family history of abnormal eye movements

Early-onset (childhood) Nystagmus

Congenital Nystagmus Latent Nystagmus

Monocular Nystagmus of Childhood

Spasmus Mutans

Congenital Nystagmus
Recognized in the first few months of life Family history

Usually dont have oscillopsia

May occur in the presence of poor vision or good acuity Often occurs as ocular albinism, achromatopsia, Leber congenital amaurosis and aniridia

 Two characteristics signs of Congenital Nistagmus : 1. Reversal of the normal pattern of photokinetic nystagmus characterized by the slow phase of the eye movements moving in the direction opposite that of rotating photokinetic drum 2. A unique pattern in which the velocity of the slow phase movement increases exponentially with distance from fixation;this requires eye movements recordings.

Latent Nystagmus
Conjugate jerk nystagmus Beginning or accentuation when binocular fusion is disrupted Direction changing with monocular occlusion : fast phase beats toward viewing eye; slow phase, toward the nose Congenital esotropia usually present Subnormal stereopsis

May be seen with congenital nystagmus in the same patient

 Rare

Monocular Nystagmus of Childhood

The eye movements are usually in 1 eye, vertical or elliptical and of small amplitude. Monocular nystagmus in an eye with poor vision is often reffered to as the Heimann-Bielschowsky phenomenon. It may occur with a variety of underlying pathohysiologies, including optic neuropathy and amblyopia.

Spasmus Nutans

intermittent, binocular, very small amplitude, high frequency, horizontal, pendular nystagmus.

Typically a benign disorder and patients generally have no other neurologic abnormalities, except perhaps strabismus and amblyopia. Typically, the abnormal eye and head movements dissapear after several years (usually by the end of the first decade of life)

Gaze-Evoked Nystagmus
Because of an inability to miantain fixation in eccentric gaze. The amplitude of the nystagmus increases as the eyes are moved in the direction of the fast phase. Caused by dysfunction of the neural integrator.

Vestibular Nystagmus

Downbeat Nystagmus
The most common form of central vestibular nystagmus and results from defective vertical gaze holding that allows for a pathologic upward drift of the eyes In some cases of unexplained downbeat nystagmus, antibodies to glutamic acid decarboxylase have been discovered in the blood of affected patients

Differential Diagnosis of Downbeat Nystagmus

Demyelination Stroke

Cranial trauma
Drugs Platybasia Tumors

Upbeat Nystagmus
Caused by an inappropriate downward drift of the eyes, followed by coorective, upward saccades.

Common causes : demyelination, stroke, cerebellar degeneration, tobacco smoking.

Torsional Nystagmus
Mixed pattern of nystagmus seen with peripheral vestibular disease, purely torsional is indicative of a central lesion. Usually associated with a medullary lesion and may be part of an ocular tilt reaction

Periodic Alternating Nystagmus

Strictly horizontal nystagmus that predictably oscillates in direction, amplitude, and frequency May be congenital and acquired.

Common causes include multiple sclerosis. cerebellar degeneration. Arnold-Chiari type I malformation, stroke, anticonvulsant therapy, and bilateral visual loss. If the last is reversible (eg. vitreous hemorrhage).

Hoffer Q
Lebih akurat pada mata dengan panjang bola mata < 22.00 mm.

ACD = ((A Constant x 0.5663)-65.6+3.595) / 0.9704

Binkhorst Formula

Thank You

Nistagmus
Gerakan mata ke 2 arah scr involunter, ritmik dan berulang. Ok ketidakmampuan mata untuk fiksasi

Nilai: kecepatan, amplitudo, lamanya gerakan

Dibedakan menurut arah gerakan: horizontal, vertikal, rotator, gabungan

Bila sama besar kedua arah: Nistagmus pendular

Ada komponen cepat dan lambat: nistagmus jerky

Jerk nystagmus is a rhythmic eye oscillation characterized by a slow drift of the eyes in one direction that is repeatedly corrected by fast movements in the reverse direction. In most cases the slow drift is the problem, of which there are two main causes: A tonic imbalance in a "slow eye movement" system, such as the vestibular or pursuit systems. This is most often due to an acute asymmetry in vestibular activity, either peripheral or central. (See "Overview of nystagmus".) An inability to hold an eccentric eye position against the normal viscoelastic forces that tend to bring the eye back to midline ("gazeholding").

In both types, corrective fast eye movements restore the eye to its desired position. These quick or fast phases are likely generated through the same brainstem structures that create saccades.

Jerk nystagmus is subdivided by trajectory and the conditions under which it occurs (table 1). Some forms are always present, even when the eyes are in the primary position. Nystagmus in the primary position is classified according to trajectory: downbeat; upbeat; horizontal; torsional; or mixed. The direction named is the direction of the fast phase. Other forms emerge only under specific conditions such as peripheral gaze (gaze-evoked) and certain head positions (positional).