Nystagmus (Eye Tremor): Causes, Treatment & Help

Nystagmus, or eye tremor, represents a restriction of vision. It occurs even in healthy people and is therefore not pathological in every case. The nystagmus is to be distinguished from eye twitching and eye flickering.

What is nystagmus?

Eye tremor (nystagmus) is generally understood to be an involuntary eye movement in a horizontal direction. Eye tremor (nystagmus) is generally understood to be an involuntary eye movement in a horizontal direction. It is not always a disease, because eye tremor also occurs in daily life. If a point in the distance is aimed at during a train ride, the eye flaps to its maximum position and is then jerkily moved back. Weakness of gaze hold is assumed in the so-called latent nystagmus (end-position nystagmus). Here, an object in motion cannot be fixed long enough without the eye moving back to its initial position. This form of eye tremor often occurs in patients who already suffer from strabismus in the first two years of life. Another manifestation of eye tremor is primary congenital nystagmus. It is congenital, but weakens during childhood. It occurs more intensely when the patient fixates on an object. Ocular nystagmus, on the other hand, is an acquired form of eye tremor that occurs as a result of another eye disease. In this case, the eye oscillates during the first months of life. These movements progressively weaken. When this form occurs after the sixth month of life, jerky eye tremor is more common.

Causes

The causes of both primary congenital and latent eye tremor are largely unknown. Both forms are congenital or acquired in early childhood. In congenital nystagmus, recessive inheritance may occur. However, this rarely occurs. Ocular nystagmus is caused by a previous disease of the eye. This includes cataract, which is a clouding of the eye lens. In addition, there is optic atrophy. Here a decrease of the tissue occurs at the optic nerve. Aniridia is a congenital eye disease. The patients lack the iris. In albinism, a genetically caused lack of pigment leads to limitations in visual acuity. Scarring of the retina also causes visual disturbances and limitations in visual acuity associated with eye tremors.

Diseases with this symptom

  • Cataract
  • Aniridia
  • Ataxia
  • Color blindness
  • Concussion
  • Retinitis pigmentosa

Diagnosis and course

To diagnose eye tremor, the ophthalmologist uses Frenzel glasses. With them, he can see the eye in significantly magnified image and thus assess the horizontal deflections. The frequency of the tremor, as well as the amplitude and the direction of the eye’s beats, are crucial. The physician can provoke the nystagmus by means of a thermal test. This is done by flushing the ear with cold and warm water. Another method of provocation is the swivel chair test. For this, the patient is made to move in a swivel chair. Due to his attempts to fixate a point, the eye tremor is triggered and occurs in the opposite direction after the chair is stopped. The deviant activity of the eye muscles must also be assessed. Electrooculography (EOG) is used for this purpose. Eye tremor can cause the patient to have forced postures of the head. In addition, untreated nystagmus leads to a decrease in visual acuity of both eyes.

Complications

Nystagmus, which is a stiffening, trembling, or miscoordination of the eyes, is not considered just a limitation of vision. If not counteracted, nystagmus can lead to complications that can affect the entire ophthalmic apparatus. Normally, a nystagmus is only temporary and subsides when the source of stress is permanently removed, for example, when the computer workstation is left, with sufficient recreational leave or regular eye exercises. But this overload syndrome can lead to a permanent reduction in visual acuity. Therefore, eye tests and examinations should be carried out in good time and on a regular basis, ideally even financed by the employer, or the necessary visual aid.However, nystagmus can be triggered not only by strenuous work in front of a screen or, for example, strenuous night driving, but also by drug abuse. Long-term complications of drug abuse, as far as the eyes are concerned, include not only nystagmus but also visual hallucinations, which must be considered together depending on their course. In purely cognitive terms, nystagmus manifests itself by the fact that focusing with the eyes is difficult or, in extreme cases, painful or even no longer possible with precision. Therefore, headaches or migraines often accompany the symptoms, which can become chronic in the long run. Furthermore, an increase in complications occurs when various sources of stress add up, such as strenuous night work under poor lighting conditions.

When should you see a doctor?

If nystagmus occurs only temporarily, a doctor’s visit is not necessary. In the case of nystagmus that is not pathological (physiological nystagmus), eye function returns to normal after a short time. However, the pathological form of this eye disease (pathological nystagmus) should not be left untreated, otherwise visual acuity is permanently reduced. A suitable contact person in this case is initially an ophthalmologist. Depending on the cause of the disease, however, a neurologist or ENT specialist may also be consulted. If the eye tremor often occurs both at rest and during movement, a visit to the doctor is advisable as soon as possible. Dizziness and a trembling perception of the surroundings are signs of a pathologically caused nystagmus. The cause may lie in the brain and should therefore be clarified. Eye injuries can also be the reason for eye tremor. If the symptoms occur in connection with an injury, a doctor should be consulted. In this way, possible further complications can be prevented. Drug consumption, for example of ecstasy, can also trigger nystagmus. Since both the sense of balance and the sense of vision can be disturbed in this case, the ophthalmologist will work together with other specialists to make a comprehensive diagnosis and work out treatment options.

Treatment and therapy

The treatment of eye tremor should provide the patient with a significant improvement in visual acuity. This can be achieved by integrating prismatic lenses into normal eyeglasses. In the case of congenital forms of eye tremor, it is sometimes more advantageous to additionally perform surgery. In this case, a compulsive head posture can also be corrected. To calm eye tremor in side gaze, the eye muscles are shifted so that patients can direct their gaze straight ahead in the future. If the eye tremor calms down in patients with close-up vision, there are also surgical procedures to correct the eye muscles. Combined fitting with prism glasses can then provide the necessary relief.

Outlook and prognosis

When nystagmus is mild, use of the healthy eye can be compensatory in some people. In this case, the existing visual acuity is perfectly sufficient, so no further action needs to be taken. Without medical help, there is no improvement in the state of health of people suffering from a congenital or acquired disorder. With the use of a visual aid, there is often an alleviation of the symptoms. However, the use of glasses or contact lenses does not lead to a permanent reduction of the symptoms, as the visual aid only has a supporting effect on the eyes. A long-lasting improvement of the nystagmus can be achieved by a surgical intervention. The prospects for this are considered quite good. Eye muscle surgery helps many sufferers achieve a good prognosis and a permanent increase in visual acuity. Good results are also achieved with drug treatment. However, as soon as the medication is discontinued, a relapse occurs and the eye tremor recurs. For people who do not have permanent eye tremor, it is often sufficient to adopt a sparing behavior. Sufficient sleep as well as the avoidance of certain stimuli sometimes cause a spontaneous healing. Situations in which an object cannot be fixed long enough due to movements taking place should be avoided completely.

Prevention

There are no preventive measures against eye tremor, which is mostly congenital or acquired in early childhood.Considering the decline in visual acuity, it is important to consult your ophthalmologist immediately if you notice any abnormalities to have the cause of the eye tremor clarified.

What you can do yourself

If nystagmus is not a severe case, it can be easily counteracted with conscious behaviors. Caution: in the case of pathological nystagmus, the following tips will not help. In this case, medical treatment is necessary. The self-help tips are intended exclusively for spontaneously occurring eye tremors. If little sleep in the days before the occurrence of eye tremor is the cause, a longer night’s rest will provide rapid relief. A stress-free environment can also help the symptom subside soon. Occurring stress is best reduced with relaxation techniques such as yoga or autogenic training, which in turn help to reduce nystagmus. Certain stimuli can also trigger nystagmus. With sufficient rest and recuperation, an improvement soon occurs. It is often sufficient, for example, if patients reduce screen work and rest instead. Certain eye exercises can also help against the tremor. It is also important to avoid focusing on a distant point – for example, when looking at the scenery during a car ride. This can aggravate or retrigger the nystagmus, since the eye cannot fixate on a specific object in this situation. Thus, the patient should not look out the window while driving to allow the eye to recover.