Some patients have a disorder in which the eyes wobble. The most common type of wobble is called nystagmus. If a patient has nystagmus the eyes can move sideways, vertical, or in a rotating fashion. Only rarely is there a localized neuro-ophthalmic abnormality causing this problem.
The work-up includes a complete neuro-ophthalmic exam with metabolic testing, neuro-imaging and examination of the spinal fluid. Although there are surgical opportunities for this abnormality, we typically try drug therapy first. Doses of either clonazepam or carbamazepine can reduce the symptoms and signs of nystagmus. The goal with nystagmus is to maintain the highest degree of visual acuity possible. Many patients with nystagmus do not notice any degradation of their vision even with the eyes moving. There are however some patients whose vision improves as we slow the motion.
The motion can also be slowed with surgery. There are a variety of techniques to help with this. The most common approach is to fix the muscle posteriorly.
The patient’s defense mechanism against this nystagmus is called convergence. The more the eyes are pulled together by the medial rectus muscles on either side, the less there is an opportunity for them to wobble. This however in some patients leads to double vision. This can be corrected with prisms to great advantage of many patients.