Nystagmus examination

• Observe the eye for any abnormal head posture which may be used to dampen nystagmus (to achieve null point) especially in those with congenital nystagmus.
• Look for any nystagmus in the primary position. Observe for:
its plane: horizontal, vertical, rotatory or see-saw
its type: jerk (phases of unequal velocity) or pendular (phases with equal velocity)
its direction: direction of the fast phase in jerky nystagmus
its amplitude: fine, medium or coarse
 
• Perform the ocular motility by getting the patient to fixate on an object (such as your finger or a picture) placed about 1/2 metres away. Move the object from right to left, upwards and downwards. Place the object at least 5 seconds at each direction to elicit the nystagmus. Observe if the amplitude of the nystagmus is increased or decreased in each direction.
Tip 1: Avoid extreme of gaze in each direction as this may elicit physiological nystagmus
Tip 2: In jerky nystagmus, the amplitude is increased when the eyes turn in the direction of the quick phase.
 
• Ask the patient to fixate on a distant object (such as a Snellen's chart) and then on an accommodative target (such as a picture). Observe for any dampening of amplitude (null point) with convergence when the eyes accommodate.

• Perform cover test on each eye in turn to elicit manifest latent nystagmus.

• You may be asked to perform further examination based on your findings.
Tip 1: In the presence of jerky nystagmus or internuclear ophthalmoplegia, look for cerebellar signs such as pass-pointing or disdiadochokinesia
Tip 2  In pendular nystagmus, look for conditions such as ocular albinism, congenital cataract or optic nerve hypoplasia.
Tip 3: In see-saw nystagmus, test for bitemporal hemianopia.
 
 
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