Acquired and
congenital nystagmus often causes decreased visual acuity as a direct result of the inability to maintain stable foveal vision. In addition, acquired nystagmus causes a disabling subjective sensation of movement of the visual world called oscillopsia. The eye movements themselves do not require treatment if the patient is asymptomatic. However,
therapy is necessary if visual disability is present. Treatments based in pharmacologic mechanisms are preferred. There are few controlled treatment trials and therapeutic efficacy generally is sought in a trial and error approach, depending on the type of nystagmus present. Treatment with
3,4-diaminopyridine and
4-aminopyridine recently have been shown to be effective for downbeat nystagmus.
Gabapentin,
baclofen, and
clonazepam also are useful in some patients with downbeat nystagmus.
Baclofen is the
therapy of choice for
periodic alternating nystagmus.
Gabapentin often is effective for acquired
pendular nystagmus.
Clonazepam and
valproate also may be effective for acquired
pendular nystagmus.
Memantine now is available in the United States and is promising in the treatment of
pendular nystagmus.
Optical devices that negate the negative effects of nystagmus continue to undergo development research. These and other medical, surgical, and
optical devices are potentially useful alone or in combination with other
therapies.