Introduction
Nystagmus is a condition that causes involuntary, rapid movement of one or both eyes. It often occurs with vision problems, including blurred vision. This condition is sometimes called “dancing eyes.” It is a feeling like the eyes have a mind of their own. They move up and down, side to side, or in a circle. It’s a condition where the person can’t control his/her eye movements.
Signs & symptoms
The symptoms include fast, uncontrollable eye movements. The direction of movement determines the type of nystagmus:
- Horizontal nystagmus involves side-to-side eye movements.
- Vertical nystagmus involves up-and-down eye movements.
- Rotatory, or torsional, nystagmus involves circular movements.
These movements may occur in one or both eyes depending on the cause. Movement of eyes without control is the most important sign. It might be fast, then slow, then fast again. It might affect one eye, but it’s usually in both eyes. There can be other difficulties including:
- Difficulty in steady gazing. Things look clearer when the head is tilted or turned.
- Blurred vision.
- Night blindness
- Photosensitivity
Causes
It may be a sign of another eye problem or medical condition. It can be present from birth or it can be developed later in life. Nystagmus is caused by many different things, including:
- Being passed down from parents
- Other eye issues, like cataracts or strabismus
- Diseases like stroke, multiple sclerosis, or Meniere’s disease
- Head injury
- Inner ear problems
- Certain medications, like lithium or drugs for seizures like phenytoin
- Alcohol or drug use
- B-12 or thiamine deficiencies
- brain tumours
Pathophysiology
Gaze-evoked nystagmus is produced by the attempted maintenance of an extreme eye position. It is the most common form of nystagmus. Gaze-evoked nystagmus is due to a deficient eye position signal in the neural integrator network. Thus, the eyes cannot be maintained at an eccentric orbital position and are pulled back toward primary position by the elastic forces of the orbital fascia. Then, corrective saccade moves the eyes back toward the eccentric position in the orbit.
Gaze-evoked nystagmus may be caused by structural lesions that involve the neural integrator network, which is dispersed between the vestibulocerebellum, the medulla (region of the nucleus prepositus hypoglossi and adjacent medial vestibular nucleus, and the interstitial nucleus of Cajal (INC). Patients recovering from a gaze palsy go through a period where they are able to gaze in the direction of the previous palsy, but they are unable to sustain gaze in that direction; therefore, the eyes drift slowly back toward primary position followed by a corrective saccade. When this is repeated, a gaze-evoked or gaze-paretic nystagmus results.
Gaze-evoked nystagmus often is encountered in healthy patients; in which case, it is called end-point nystagmus. End-point nystagmus usually can be differentiated from gaze-evoked nystagmus caused by disease, in that the former has lower intensity and, more importantly, is not associated with other ocular motor abnormalities.
Abducting nystagmus of internuclear ophthalmoplegia (INO) is, as the name implies, nystagmus in the abducting eye contralateral to a medial longitudinal fasciculus (MLF) lesion
Periodic alternating nystagmus is a conjugate, horizontal jerk nystagmus with the fast phase beating in one direction for a period of approximately 1-2 minutes. The nystagmus has an intervening neutral phase lasting 10-20 seconds; the nystagmus begins to beat in the opposite direction for 1-2 minutes; then, the process repeats itself. The presumed mechanism is disruption of the vestibulo-ocular tracts at the pontomedullary junction.
Diagnosis
- Ophthalmic evaluation
- Vision acuity test
- Spinning chair test
- Ear examination
- Neurological exam
- Brain MRI
- Brain CT scan
- Recording of eye movement
Treatments
Congenital nystagmus doesn’t require treatment, although the following may help improve the vision:
- eyeglasses
- contact lenses
- increased lighting around the house
Sometimes, congenital nystagmus lessens over the course of childhood without treatment.
In children with severe cases, surgery called a tenotomy to change the position of the muscles that control eye movement may be helpful.
Such surgery can’t cure nystagmus, but it can reduce the tilting of the head to improve the vision.
In acquired nystagmus, treatment will focus on the underlying cause. Some common treatments for acquired nystagmus include:
- changing medications
- correcting vitamin deficiencies with supplements and dietary adjustments
- medicated eye drops for eye infections
- antibiotics for infections of the inner ear
- botulinum toxin to treat severe disturbances in vision caused by eye movement
- special glasses lenses called prisms
- brain surgery for central nervous system disorders or brain diseases
Prognosis
Nystagmus may improve over time with or without treatment. However, nystagmus usually never goes away completely.
Complications
- Brain damage
- Difficulty walking and maintaining balance
- Loss of cognitive abilities
- Paralysis
- Permanent disability
- Unconsciousness and coma.
Disease & Ayurveda
There is no exact Ayurvedic term for nystagmus. Yet the uncontrollable and abnormal movements of eyelids come under vitiated Vaata dosha signs.
Nidana
Physical
Dry, cold and old food items
Excess travelling & exertion
Trauma/injury
Exposure to wind
Loss of sleep
Psychological
Mental trauma or grief
Fear
Anxiety
Purvaaroopa
Not mentioned
Samprapti
Due to either obstruction to channels, or depletion of body tissues, the movement of Vaata gets deranged. The normal functions of Vaayu when disturbed like this and gets lodged in eyes and the muscles around eyes, it produces the disorder like nystagmus.
Lakshana
Uncontrollable eye movements
Divisions
Not mentioned
Prognosis
Yaapya
Samana
Ayurvedic treatment for nystagmus depends upon the cause for Vaatakopa and any associated dosha present. If Vaata is vitiated due to obstruction in channels/Kapha is the associated vitiated dosha, first approach should be to remove the accumulated toxic metabolic waste (Aama) from the body. It can be done by drying up and body-lightening therapies like:
Lepanam with Rookshana dravyas
Swedanam
Mild fasting
If the Vaatakopa is due to degeneration and Vaata-Pitta doshas are aggravated, only mild Aamapaachana with some medicines or diet modifications will be enough. The treatment with snehana swedana sodhana panchakarma and then bruhana will be more suitable in this case.
Localised application of medicines in eyes are also done.
Sodhana
Snehana-swedana
Virechana
Nasya-dhoomapana
Kashayavasti
Snehvaasti
Commonly used medicines
Pathyakshadhatryadi kashayam
Dhanwantharam Kashayam
Balajeerakadi Kashayam
Dhanadanayanadi Kashayam
Shaddharana Churna
Thriphalachoornam
Ksheerabala tailam
Dhanwantaram tailam
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Home remedies
No home remedies are proven to cure nystagmus
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha, cause obstruction in channels and obesity
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, honey
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from cold climate.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid sedentary lifestyle.
Yoga
Regular stretching and mild cardio exercises are advised. Also, specific yogacharya including naadisuddhi pranayama, bhujangaasana, pavanamuktasana is recommended.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Pavanamuktasana
Nadisudhi pranayama
Bhujangasana
Along with yoga for whole body, special yoga techniques for eyes should also be done.
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1279674/
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