An increased compendium of drugs useful in ocular motor system dysfunction has expanded our capacity to treat selected
ocular motility disorders. Adjunctive therapeutic modes (e.g., Fresnel prisms and
orthoptic exercises) can also be beneficial. PAN and
see-saw nystagmus can be treated with
baclofen. Downbeat nystagmus may respond to
clonazepam therapy, and prisms may help if the nystagmus can be modified with convergence.
Congenital nystagmus may respond minimally to drugs (e.g.,
baclofen), but prisms or
surgical procedures, or both, are still the primary treatment modalities.
Innovar may be helpful in patients with severe, incapacitating vestibular disorders, and
scopolamine alone or in combination with
promethazine may be beneficial in patients with milder ambulatory acute peripheral vestibular disorders. Benign
positional vertigo is best treated initially with positional exercises before
drug therapy is instituted.
Opsoclonus and ocular flutter have been treated successfully with
corticosteroids,
propranolol, and
clonazepam, while microflutter, an extremely rare disorder, can resolve with
baclofen. Although
therapy with
carbamazepine, 5-hydroxtryptophan, and
scopolamine has been useful in selected patients with ocular
palatal myoclonus, most do not respond to
drug treatment. It is not usually necessary to treat voluntary nystagmus, but Fresnel prism
lenses should be remembered in refractory patients. Potentially reversible and pseudointernuclear
ophthalmoplegias also were discussed.
Orthoptic exercises can be beneficial in posttraumatic
internuclear ophthalmoplegia. Selected supranuclear
palsies can be improved completely with the proper
drug regimen. Lastly,
superior oblique myokymia can be treated successfully with
carbamazepine, with tight surveillance for possible adverse side effects. Descriptive phenomenology and pathophysiological localization must be correlated with brain stem neurochemistry and neuropharmacology to medically treat additional ocular motor system disorders.