Congenital nystagmus, or nystagmus in babies, affects about one in every 5,000 live births and usually appears between the ages of six weeks and six months. Nystagmus is an ocular condition wherein the eyes exhibit recurrent, unpredictable, and random jerky movements. During visual development, your baby’s eyes will wander around to follow objects, voices, or people around them. However, nystagmus causes neonates to have more frequent and consistent eye movements than normal, which can be multi-directional, including horizontal, vertical, and torsional (1).
Nystagmus can be caused by various medical disorders and may be linked to vision impairment or impaired eyesight in many babies. Read on to know the causes, symptoms, risk factors, diagnosis, and treatments for nystagmus in babies.
Types Of Nystagmus In Babies
Nystagmus in babies is called infantile nystagmus, and it can be classified into the following two types (2).
1. Congenital nystagmus
Congenital nystagmus is present at birth or occurs within the first six months of life. This can be further classified into two types.
- Congenital sensory nystagmus: This is nystagmus due to something that interferes with visual information reaching the brain. Babies with congenital sensory nystagmus have abnormal vision. This is called afferent sensory defect since the sensory information, such as vision, to the brain is interrupted. Refractive errors, optic nerve and retinal problems, and congenital cataracts are common causes of this type of nystagmus in babies.
- Congenital motor nystagmus: According to the American Association for Pediatric Ophthalmology and Strabismus (AAPOS), congenital nystagmus is a more common type. Babies may have normal vision and no underlying causes of this type. This can be due to the brain lacking stability control or motor skills of eye movement. Brian and vision can be otherwise healthy other than nystagmus.
2. Acquired infantile nystagmus
Acquired nystagmus develops any time after six months of age. This can be due to various reasons such as brain abnormalities, eye and head trauma, and responses to certain medications. Imaging tests such as MRI scans help to identify the underlying causes of acquired nystagmus.
Infantile nystagmus can also be classified based on the eye movements into pendular nystagmus, where the eyes move at an equal velocity in each direction and jerk nystagmus when the eyes move fast to one direction and slowly to the opposite direction.
Signs And Symptoms Of Nystagmus In Babies
Rapid, involuntary, jerky eye movement is the primary symptom of nystagmus in babies. This can be uniplanar, pendular eye movement. The intensity and frequency of these eye movements may vary in each baby. Nystagmus may occur in one or both eyes. You may not notice eye movements when the baby is asleep.
Other symptoms of nystagmus in babies may include (3):
- Photosensitivity (sensitivity to light)
- Difficulty using eyes to follow objects
- Holding the head in a tilted position
Eyes are objectively normal in babies with nystagmus. There can be a null zone that is a position where the oscillations (nystagmus) are less, and the vision is good. Most babies with null zones adopt abnormal head positions for better vision.
Seek the consultation of a pediatric ophthalmologist if your baby has nystagmus. Some symptoms, such as blurred vision, night vision problems, dizziness, and balance issues, are more noticeable in older children.
Causes And Risk Factors For Nystagmus
Congenital neurological problems are the most common cause of nystagmus in babies. Some babies may develop neurological issues after birth. Other causes may include (3):
- Congenital cataracts
- Central nervous system illnesses
- Issues with the development of eye movement control
- High refractive errors, such as high myopia (nearsightedness) or astigmatism
- Inner ear inflammation
- Medications such as anti-seizure drugs
In addition, balance and vestibular disorders can also lead to nystagmus in babies. Diseases such as multiple sclerosis, stroke, and trauma may result in acquired nystagmus later in life.
Diagnosis Of Nystagmus In Babies
Doctors may observe the eye movements and head positioning of your baby. Detailed family history can be asked since congenital motor nystagmus can be hereditary. A visual acuity test is done in most babies. Congenital motor nystagmus can be associated with relatively better visual acuity than sensory defect nystagmus (4).
Light sensitivity with strabismus in bright light can be seen in some babies. Abnormal photopic cells are seen in electroretinograms. CT scan and MRI scan are needed to look for neurological causes of nystagmus. Congenital cataracts, ocular albinism, and optic nerve hypoplasia can be observed on a slit-lamp exam (5).
Treatment For Nystagmus In Babies
Nystagmus treatment primarily focuses on the correction of refractive error. Sensory deficit of vision in nystagmus cannot be corrected. Existing treatments strategies help to reduce the intensity and frequency of nystagmus.
Treatments for nystagmus may include (6):
- Pharmacological treatments: Various drugs such as diethyl propionate, baclofen, gabapentin, and botulinum toxin injection improve visual acuity and reduce the frequency of nystagmus.
- Surgical treatments: Kestenbaum-Anderson resection and other resection procedures are surgical treatments for improving abnormal head posture and reducing the frequency of eye movements. Tenotomy (eye muscle removal and reattachment) and extraocular muscle resection or a combination of these surgeries is also recommended.
- Vision rehabilitation: This is recommended for babies who are born with vision impairments, and may be considered as the baby grows older. Rehabilitation training teaches children to use electronic or optic magnification devices and other adaptive ways.
- Eyeglasses and contact lenses: Babies with refractive errors are provided with eyeglasses or lenses to correct the refractive error. These treatments do not correct nystagmus, and only improve vision. Eye patches are often recommended to prevent complications of refractive problems such as amblyopia (lazy eye).
All these procedures help improve nystagmus, but do not cure it. Babies may receive treatment for underlying causes of any issues that are present.
Frequently Asked Questions
1. Can nystagmus in babies go away?
The prognosis of nystagmus depends on the underlying cause. Babies may not outgrow congenital nystagmus due to developmental issues. Acquired nystagmus due to treatable conditions may go away after treating the underlying cause. For example, nystagmus due to exposure to certain medications may disappear when the compound is cleared from the body.
2. Is nystagmus linked to autism?
Autism and nystagmus may be linked. According to a population-based study in children younger than 18 years conducted using an optimum database, children with autism are nearly five times more likely to have nystagmus than children without autism (7). This study also found that autism could be linked to various ophthalmologic disorders (8). If your baby has nystagmus and you have concerns about their development, you may consult a doctor who is an autism spectrum disorder specialist.
3. Is congenital nystagmus serious?
Infantile nystagmus syndrome is usually mild, and its severity does not increase. It is seldom associated with any other disorder (9).
4. How does nystagmus affect learning?
Some children with nystagmus may be able to read normal-sized print with the help of adapted materials. However, it can be tiresome for long durations due to the additional time and effort involved in focusing. Such children’s vision may change throughout the day and worsen when they are tired or stressed. They may also find it difficult to perceive depth and distance, which may interfere with mobility or when attempting some sports activities (10).
Congenital nystagmus is an ophthalmologic condition that can be hereditary or acquired in the first six months of infancy. Seek immediate medical care if you observe rapid eye movements in your newborn. Refractive error can be corrected, and severity and frequency of movements may be reduced with present treatment options, but sensory vision deficits may not be addressed. Early identification and interventions to manage vision problems may help improve the quality of life. If the underlying condition is treatable, acquired nystagmus may also be easily addressed.
- Babies can be born with sensory or motor congenital nystagmus or develop acquired infantile nystagmus during the first six months of life.
- Jerky, involuntary, and sudden eye movements are hallmark symptoms of nystagmus, and it can also be associated with sensitivity to light or the inability of the eyes to follow objects.
- Nystagmus can be treated with medications or surgery, and eyeglasses or lenses and visual rehabilitation are recommended depending on the severity of vision impairment.
- X-linked Infantile Nystagmus.
- R V Abadi and A Bjerre; Motor and Sensory Characteristics of Infantile Nystagmus.
- Katie Flickinger and Jeremiah P. Tao, How to Assess and Treat Infantile Nystagmus.
- Morgan Bersch, et al., The clinical evaluation of infantile nystagmus: What to do first and why.
- Kimberly Penix, et al., Nystagmus in pediatric patients: Interventions and patient-focused perspectives.
- Melinda Y Chang, et al., Prevalence of Ophthalmologic Diagnoses in Children With Autism Spectrum Disorder Using the Optum Dataset: A Population-Based Study.
- Eyeing the connection between autism and vision.
- Nystagmus booklet for teachers.