The occurrence of nystagmus is due to the action of many different factors of general and local significance. This kind of pathology of the organs of vision is externally manifested by the inability to fix the gaze, since the eyeballs involuntarily “run”, making oscillatory movements (up to several hundred such oscillations per minute).
Experts tend to argue that the occurrence of pathology is most often associated with the professional activities of patients. In particular, nystagmus is found in miners whose working conditions leave much to be desired.
Poor lighting and poor ventilation cause workers of this specification to overstrain some of the eye muscles, as they have to constantly direct their gaze up and to the sides. This fact causes the eyeballs to move up and to the sides, which causes the development of nystagmus.
General information
Nystagmus (translated from Greek as drowsiness) means a state of pathological disorder of visual function, in which rhythmic vibrations of the eyeballs of high frequency, uncontrollable by a person, are observed. Most often, bilateral ocular (fixation) nystagmus occurs, less often - unilateral.
As a deviation from the norm, the disease occurs when the vestibular apparatus is damaged, in the process of changes in functions of the cerebellum, with inflammation of the inner ear, which is caused by numerous traumatic brain injuries, infectious and toxic damage to the brain, and oncology.
It is extremely rare that nystagmus manifests itself as a result of the development of diseases of the organs of vision.
Forms and types of nystagmus
The disease can occur in completely healthy people. According to the nature of eye movements, nystagmus occurs:
- undulating (pendulum-like) – characterized by oscillatory phases of equal magnitude
- rhythmic (jerky) – when the slow phase of movement in one direction is replaced by a fast phase of movement in the other direction
- mixed - may appear pendulum-like when looking forward, but have signs of rhythm when looking to the side
The following forms of pathologies are distinguished:
physiological nystagmus in the form of tremor or drift occurs at a moment of strong excitement or irritation, is divided into:
- optokinetic (so-called railway) - most often occurs when carefully viewing objects flashing before the eyes and is directed in the direction opposite to the movement of flashing objects
- labyrinthine, clearly defined jerky - its appearance is associated with irritation of the labyrinth zone of the balance organ in the form of heat/cold, the action of galvanic currents, and can also occur as a result of human rotation along the horizontal axis
- nystagmoid twitching of the eyes - observed at the moment of their extreme abduction to the side and the reason for everything is increased fatigue of the eye muscles
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pathological nystagmus is characterized by congenital or acquired visual impairment resulting from damage to various parts of the brain, the organ of balance (vestibular apparatus), dysfunction of the pituitary gland, intoxication with narcotic drugs, it happens:
- ocular – fixation, caused by a disorder of visual fixation due to a malfunction of the regulatory mechanism; may occur due to congenital (hereditary) pathologies of the oculomotor system or due to weakness of visual function acquired at an early age due to diseases of the visual organs
- professional – noted in the patient as a result of many years of work in mines, where, in addition to poor lighting and ventilation, an additional factor of intense eye fatigue is intoxication with mine gases (methane, carbon monoxide);
- labyrinthine - peripheral (horizontal or rotatory) develops when the inner ear is damaged;
- neurogenic – central manifests itself as a result of disturbances in the oculomotor reflex
The direction of nystagmus is always determined by the rapid phase of oscillation of the eyeball. In medical practice, horizontal nystagmus is more common, and vertical or diagonal is much less common.
In addition, it is necessary to take into account that with dissociated nystagmus, non-monotypic movement of the eyeballs is observed, while with associated nystagmus, it is invariably the same.
Nystagmus in children
The worst thing for parents is the illness of their beloved child. Therefore, the appearance of nystagmus becomes an alarming moment for moms and dads. Considering that the vibrations of the eyeballs can also be physiological, nystagmus, as a symptom, will manifest itself no earlier than 2 months.
In a newborn, the visual system is not yet fully developed, so “wandering” eyes are associated with the fact that the child is not able to fix his gaze on an object. Therefore, involuntary eye movements may be normal. Some pediatricians don't even pay attention to this. However, if there is a history of birth trauma, rapid labor, or albinism in relatives, such children should also be observed by an ophthalmologist and neurologist until the age of 1 year.
In the first year of life, the organ of vision matures as a visual analyzer. And if the oscillatory movements intensify by 6 months, then this is already a reason to sound the alarm. Lesions of the central nervous system primarily cause the appearance of nystagmus in children in the first year of life.
At birth, the child is not able to fix his gaze due to the immaturity of the visual analyzer. However, by 1 month of life, the fixation ability in children is fully established. If at the age of 1 month parents observe “wandering” eyes, then the child should be examined by a neurologist and ophthalmologist. The scope of examinations and observation tactics will be determined directly by the doctor on an individual basis.
You should always remember that the earlier a disease is detected, the easier it is to treat.
Clinical picture
As a rule, hereditary eye damage or the detection of ocular nystagmus in early childhood is persistent, which does not change with age.
In addition, with congenital pathology of the oculomotor system, there is a complete absence of changes in the refractive media (opacity of the cornea or lens), as well as in the photosensitive apparatus (retinal pigment degeneration, albinism, optic nerve atrophy, etc.).
Most often with the disease, oscillatory movements of the eyeballs are observed, the movement of which is rotatory or mixed in nature. It has been noted that nystagmus can intensify when the body is tilted back and forth or to the sides.
With a jerky form of nystagmus, the amplitude of oscillations decreases with head turns towards the fast phase. Often, visual acuity is significantly reduced and does not exceed 0.3 diopters.
The patient complains of being forced to hold his head in a certain position, the appearance of eyelid trembling, photophobia and blurred vision, which significantly reduces the patient’s adaptation and adaptability to living conditions.
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Reasons for appearance
Source: linza.guru
Most often, this type of eye disease is diagnosed a year during the first preventive examination in a children's clinic.
It is at this age that involuntary fluctuations of the eyeball and the inability to focus on an object or object are considered a pathology. The following factors provoke nystagmus in children:
- hereditary predisposition of the child;
- congenital disorders of the nervous system or their appearance as a result of injuries during birth;
- myopia;
- traumatic brain injuries;
- infection in the ear and, as a result, illness;
- taking medications by the expectant mother that are prohibited during pregnancy;
- parental use of drugs and alcohol before conception and during the entire course of pregnancy by the mother.
In an adult, the disease can be provoked by stress and nervous tension. Therefore, it is so important to conduct an examination not only with an ophthalmologist, but also with a neurologist at the first symptoms.
Diagnosis and treatment of the disease
Diagnosis does not present any difficulties. Detection of the disease is carried out through a visual examination by an ophthalmologist, who fixes the finger at a distance of at least 20-30 cm to the side of the patient’s temple, in turn on both sides.
Also during the examination, an effective method of electronystagmography is used, the action of which is based on a graphic recording of the biopotential of the eyeball, which changes with eye movement.
It should be noted that the treatment of nystagmus is a very difficult and, for the most part, unsuccessful process. Long-term therapeutic and therapeutic manipulations are carried out comprehensively and are aimed at eliminating the actual causes of nystagmus.
In particular, with the help of reflexology, keratoplasty, and by wearing corrective glasses that restore the tone of the eye muscles, it is possible to achieve a significant reduction in the visual effect of nystagmus.
Conservative (medicinal) treatment is aimed at increasing visual acuity, reducing intraocular blood circulation while simultaneously activating metabolic processes at the cellular level.
Operative (surgical) intervention is indicated for the horizontal form of nystagmus.
Pathological nystagmus cannot be treated, so treatment measures are aimed at eliminating the causes of the underlying disease. Vitamin therapy and antispasmodics temporarily improve the clinical picture.
Symptoms
With nystagmus, the child’s head can often take an unnatural position. This condition is called ocular torticollis.
It arises due to the fact that with nystagmus there is always a position of the head in which the oscillatory movements appear much less or disappear completely.
The child unconsciously finds this position of the head and begins to look in this position, since due to the smaller number of oscillatory movements, the quality and acuity of vision in this position is much better. It is difficult for a child at any age to determine the presence of a health problem.
Moreover, nystagmus often develops against the background of another disease.
The disease is characterized by impaired motor activity of the eyes. In addition, the following accompanying symptoms of nystagmus may be observed:
- dizziness;
- visual impairment;
- inability to focus on a subject;
- sensation of movement of surrounding objects;
- nausea;
- hearing impairment;
- problems with coordination of movements.
With a mild form of the pathology, the patient may not even be aware of the presence of this disorder.
Symptoms largely depend on the extent of the disease. Thus, a mild degree is characterized by a complete absence of eye oscillation at rest. The movement disorder manifests itself only when the patient moves the eye to the extreme (maximum to the right or left). This form of the disease may not even be noticeable to others.
The average or second degree of the disease is characterized by visible oscillation of the eye when looking straight (central position of the eye).
The severe form or third degree is characterized by oscillatory movements of the eye while slowly looking away. For example, when looking to the right, visible fluctuations of the eye to the left are observed.
Diagnosis of the disease
When diagnosing, it is first necessary to identify the cause. This requires consultation not only with an ophthalmologist, but also with an otolaryngologist, neurosurgeon, neurologist, and sometimes an infectious disease specialist. For young children, medicated sleep is used during examinations.
Inspection plan:
- Determination of visual acuity.
- Examination of the eyeballs.
- MRI of the orbits and head.
- Examination of the fundus and retina.
- Laboratory diagnostics.
- Electroencephalography of the brain.
- Angiography of blood vessels.
- Checking with a videonystagmograph.
- Ophthalmoscopy.
- Microperimetry.
- Visometry.
When the eyes oscillate, the patient is examined with and without glasses, with different head tilts, with alternate closing of the right and left eyes. Tremor syndrome and drift are not pathological manifestations of nystagmus.
Treatment methods for nystagmus
There is no treatment for physiological nystagmus; oscillatory eye movements disappear immediately after the provoking factor is eliminated. An oculomotor disorder of a pathological nature cannot be completely cured; therapy is selected aimed at reducing the frequency of eye movements. The treatment regimen for adults is based on the elimination of the underlying disease that caused the disturbance in the oscillations of the eyeballs. If there is a brain tumor, it must be removed surgically.
To eliminate nystagmus caused by intoxication, it is enough to stop taking the drug or substance that is poisoning the body. If the problem arose against the background of central vestibulopathy, then neurotropics from the group of anticonvulsant and antiepileptic medications are prescribed. Conservative treatment of the disease may also include the following:
- anticonvulsants, vitamin eye drops, immunostimulants;
- drugs to improve brain nutrition from the group of nootropics;
- botulinum toxin injections – reduce strong eye movements;
- optical vision correction with glasses or contact lenses;
- Antibacterial therapy for the inflammatory process.
Medications may also be prescribed to reduce or eliminate symptomatic manifestations. In advanced cases, an operation is performed, the essence of which is to form a position of relative rest of the eyes by restoring the physiological position. This is accomplished by changing the structural characteristics of the extraocular muscles. The forced position of the head is eliminated and strabismus is eliminated.
Types of disease
Source: linza.guru
Horizontal
Horizontal congenital nystagmus develops extremely rarely in childhood. Its occurrence could be triggered by injuries received by the baby during childbirth or pathologies of its maturation during the woman’s pregnancy.
It can also develop as a complication after an inflammatory process in the ear or an infectious disease.
Usually, myopia, astigmatism or farsightedness occurs together with nystagmus. An infant with this visual defect often also experiences reduced visual acuity of the surrounding world.
Vertical
Vertical nystagmus: what is it, reasons for its appearance The visual system disorder is divided into two different types - congenital and acquired. Congenital pathology manifests itself after the birth of the baby, during the first months, occurs infrequently, and develops against the background of neurological disorders that are inherited by the child.
The causes of acquired eye pathology are conventionally divided into local and general.
The latter provokes:
- multiple sclerosis;
- cancer;
- stroke;
- traumatic brain injury;
- taking alcohol and drugs, as well as medications for epilepsy and seizures, to improve sleep.
Causes of local nystagmus: visual impairment (acquired and congenital): astigmatism; optic nerve atrophy; myopia; degeneration of the reticular layer; albinism.
