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Ophthalmology
Nystagmus
Built from Strabismus Simplified, Second Edition
What’s inside
9 sections · 101 slides
Description and terminology
- Definition of nystagmus
- Parameters used to describe nystagmus
- Pendular and jerk nystagmus
- Documenting nystagmus in the nine gaze positions
- Amplitude, frequency and intensity
- Alexander's law and the degrees of nystagmus
- Null zone and neutral zone
- Changing head posture in periodic alternating nystagmus
- Measuring face turn with a scale and protractor
- Conjugacy and laterality
- Graphic conventions for charting nystagmus
- Sensory and motor nystagmus
Classification of nystagmus
- Physiologic nystagmus
- Sensory nystagmus: retinal causes
- Sensory nystagmus: optic nerve and anterior segment causes
- Nystagmus associated with neurologic disease
- Neurologic, strabismus related and nystagmoid groups
- Overview of the classification
History and clinical assessment
- Role of family history
- Role of perinatal history
- Systemic features pointing to the cause
- Dysmorphic and developmental associations
- Ocular findings and the paradoxic pupil
Nystagmus with neurologic disorders
- Gaze paretic nystagmus
- Convergence retraction nystagmus and Parinaud's syndrome
- Central and peripheral vestibular nystagmus
- Acquired periodic alternating nystagmus
- Downbeat and upbeat nystagmus
- See-saw nystagmus
Recording nystagmus
- Electronystagmography and videonystagmography
- Electronystagmography recording
- Videonystagmography recording
- Reading the electronystagmogram
- Slow phase waveforms and their underlying defects
- Underlying defects of the slow eye movement subsystem
- High-gain instability and vestibular tone imbalance
- Integrator leak
Nystagmus associated with strabismus
- Non-neurologic nystagmus seen with strabismus
- Spasmus nutans
- Manifest nystagmus: definition and terminology
- Characteristics of manifest nystagmus
- Behaviour of manifest nystagmus
- Null zone and head posture in manifest nystagmus
- Electronystagmogram in manifest (infantile) nystagmus
- Latent and manifest latent nystagmus
- Direction rule in manifest latent nystagmus
- Manifest latent nystagmus
- Relative frequency of nystagmus types (Dell'Osso)
- Association with strabismus
- Charting visual acuity in latent and manifest latent nystagmus
- Differences between manifest and manifest latent nystagmus (von Noorden)
- Nystagmus blockage syndrome
- Distinguishing nystagmus blockage syndrome from infantile esotropia
- Congenital periodic alternating nystagmus
Non-surgical treatment
- Framework for treatment
- Non-surgical options
- Optical devices
- Prisms to induce fusional convergence
- Prisms in the evaluation of a face turn
- Pleoptics and occlusion
- Penalization
- Acupuncture
- Effect of acupuncture on the nystagmus recording
- Acupuncture needle used in the study
- Auditory biofeedback
- Auditory biofeedback and its duration of effect
- Medical treatment and botulinum toxin
Surgical management
- Principles of surgery for nystagmus
- Surgical procedures matched to aim
- Kestenbaum, Anderson and Goto approaches
- Planning an Anderson-Kestenbaum procedure
- Parks and Calhoun-Harley dosage schedules
- Augmented Anderson procedure
- Augmented Anderson procedure
- Reversal of head posture after surgery in PAN
- Four horizontal recti supramaximal recessions in periodic alternating nystagmus
- Vertical Kestenbaum
- Vertical anomalous head posture with chin up and eyes down
- Torsional Kestenbaum
- Vertical rectus transposition for torsional null
- Oblique muscle surgery for torsional null
- Composite electronystagmogram before and after oblique muscle surgery
- Surgery in nystagmus blockage syndrome
- Supramaximal recession of all four horizontal recti
- Approaches that are not recommended
- Supramaximal recession compared with the Hertle-Dell'Osso procedure
Summary
- Key points: description and diagnosis
- Key points: treatment
- Suggested reading
- Suggested reading (continued)
- Suggested reading (continued)
- Strabismus Simplified