++
++
Children with nystagmus should be referred for further evaluation.
This is usually done most efficiently by initially referring the
child to an ophthalmologist. Nystagmus that presents in infancy and
early childhood is usually due to either congenital motor nystagmus
or is secondary to an underlying ocular disorder. Acquired nystagmus
in older children is more likely to be associated with an underlying
neurological disorder. Older children with nystagmus may need to
be evaluated by both an ophthalmologist and a neurologist.
+++
What Shouldn’t
Be Missed
++
Sensory nystagmus in infants may be due to septo-optic dysplasia.
This is often associated with pituitary gland dysfunction. Affected
infants may not be able to mount a normal stress response and are
therefore at risk for decompensating with minor illnesses. If this
diagnosis is suspected, the infant’s family should be warned
of this possibility while waiting for an endocrinological evaluation.
+
- 1. Congenital motor nystagmus
(infantile nystagmus syndrome). In congenital motor nystagmus,
the eyes themselves are fine. The nystagmus results from abnormalities
of the ocular motor system. Despite the nystagmus, most children
see surprisingly well (Table 12–1).
- 2. Sensory nystagmus. Any disorder
that affects the vision in both eyes during infancy may present
with nystagmus in the first few months of life. The prognosis for
vision depends on the underlying disorder. Common etiologies include
albinism, optic nerve hypoplasia (septo-optic dysplasia), and Leber’s
congenital amaurosis (Table 12–2).
- 3. Acquired nystagmus in older children. Acquired
nystagmus is relatively rare in childhood. Unlike infantile nystagmus,
older children with acquired nystagmus may complain of oscillopsia,
the sensation of the world moving back and forth. Acquired nystagmus
may result from central nervous system lesions or as a side effect of
medication (Table 12–3).
- 4. Voluntary nystagmus. Some
patients are able to voluntarily elicit nystagmus. This is a high-frequency
horizontal oscillation. It cannot be sustained longer than a few
seconds.
- 5. Latent nystagmus (fusion maldevelopment
nystagmus). Patients with infantile esotropia develop nystagmus
when one of their eyes is covered. The nystagmus is usually not
visible when both eyes ...