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A Clinician’s Approach to Infantile Nystagmus

Correspondence: Requests for reprints should be addressed to: J. Raymond Buncic, M.D., Hospital for Sick Children, Ophthalmology Dept., 555 University Ave., Toronto, ON M5G 1X8, Canada.

Nystamus in the infant is an important sign of a problem in the sensory/motor loop that controls eye position stability. Nystagmus, a repetitive oscillation of the eyes, must be differentiated clinically from saccadic intrusions. In infantile nystagmus, the time of onset and the history of ocular/visual symptoms and neurological symptoms help in directing our diagnosis. The ocular examination usually helps define ocular causes, with little serious visual loss. The ERG is essential to rule out retinal causes when the eye exam seems normal. Late onset nystagmus, even though it has the clinical characteristics of an ocular type of nystagmus, should raise the possibility of brain tumor. Strabismus-associated nystagmus forms include Binocular Deficiency Nystagmus Syndrome (BDNS) and Ciancia Syndrome. Neurological types of nystagmus often have anatomically localizing value for the pathology. Some knowledge of nystagmus helps the orthoptist understand sensory consequences and the clinical perspective for analysis of eye movement disorders.

Key words: infantile nystagmus, saccadic intrusions, BDNS