Nystagmus in children causes exercises and quick treatment

Many parents are often surprised when they notice their child’s eyes moving abnormally or shaking, and they start to worry: "Is this normal? Is there a vision problem?" One of the most common conditions that can appear in infants and young children is nystagmus, which can range from mild to a sign of an underlying health issue that requires attention. This condition not only affects vision but can also impact eye development and the child’s psychological well-being. In this article, we will discuss the causes of nystagmus in children and infants, its symptoms, types, diagnosis, treatment options including medications and surgery, useful exercises, and essential tips for parents on how to care for their child effectively.

What is Nystagmus in Children?

Nystagmus is a rapid, involuntary movement of the eyes that can go side-to-side, up and down, or in a circular pattern.

Does nystagmus affect vision?
In most cases, it reduces a child’s ability to focus and see clearly. Some children may have mild to moderate vision impairment.

Can nystagmus go away on its own?
Usually not, but it may improve partially with proper treatment or eye exercises.

Can a child live a normal life?
Yes, with early diagnosis, proper treatment, and psychological support from parents, the child can live a completely normal life.

Can nystagmus appear in only one eye?
Sometimes, but in most children, it appears in both eyes.

Do infants feel pain from nystagmus?
No, nystagmus is usually painless, though it can cause eye strain or fatigue.

Can focusing on an object reduce the movement?
In some cases, the eye movement may decrease when the child focuses, but it doesn’t disappear completely.

Does every child need scans or tests?
Not all children, but in severe cases or if there are accompanying problems, the doctor may recommend MRI or eye and brain scans.

Is nystagmus linked to other health problems?
Sometimes, it appears with poor vision, strabismus, or neurological issues, especially if it’s part of a hereditary condition.

Does nystagmus affect reading or learning?
It can impact visual focus in older children, but with visual and educational support, its effects can be minimized.

Does stress or fatigue make it worse?
Yes, in some children, eye movement increases when they are tired or stressed.

Is there a difference between nystagmus in infants and adults?
Yes, in infants it’s usually noticeable from birth or within the first six months, while in adults it may appear due to acquired conditions.

Can the brain adapt to nystagmus?
Sometimes, the brain adapts, reducing the child’s awareness of discomfort, but the movement still occurs.

Does nystagmus affect daily life?
With medical follow-up and support, most children can live a completely normal life.

Is there a permanent cure for nystagmus?
Not always. Treatment usually aims to reduce symptoms, improve vision, stabilize the eyes, and sometimes includes exercises or surgery to enhance visual performance.

Can nystagmus appear suddenly after breastfeeding or after one year?
It usually appears from birth or within the first months. Sudden appearance later is very rare and requires prompt evaluation by a pediatric ophthalmologist.

Can exercises make a noticeable difference?
When done under supervision of a doctor or visual therapist, exercises can improve eye focus and reduce the effect of nystagmus on vision.

Can nystagmus cause dizziness or loss of balance?
In rare cases, especially if the eye movement is very fast, the child may feel slight unsteadiness or dizziness.

Are all types of nystagmus dangerous?
Not all cases are serious, but medical evaluation is necessary to determine the cause and prevent related health problems.

Can nystagmus be hereditary?
Yes, especially if there’s a family history, making genetic testing important.

Does the child need physical or visual therapy sessions?
Sometimes, particularly if nystagmus affects eye coordination or focus.

Can it disappear after surgery or using an artificial eye?
If the cause is muscular or optical, some surgeries or devices may reduce eye movement, but it rarely disappears completely.

Does nystagmus affect sleep in children?
Usually not, though some children may experience more eye fatigue before bedtime.

What should parents do if their child has nystagmus?
Regular follow-ups with a pediatric ophthalmologist, psychological support, and monitoring for any associated visual or neurological problems.

Causes of Nystagmus in Children and Infants

Nystagmus is an involuntary, rapid eye movement that can be horizontal, vertical, or even circular. It usually appears in the first months of life, affecting visual stability and clarity. Causes include:

Most Common Causes:

1️⃣ Genetic or congenital causes

Abnormal development of the retina or optic nerve during pregnancy.
Genetic conditions such as Albinism, which affects eye pigmentation and vision.

2️⃣ Early visual impairment
Any condition that prevents clear vision in early months may cause nystagmus, such as:

Congenital cataracts.
Corneal opacity.
Congenital retinal detachment.

3️⃣ Brain or neurological problems

Injuries or dysfunction in eye movement control centers in the brain.
Rare brain tumors or infections in infants.

4️⃣ Optic nerve problems

Weak or underdeveloped optic nerve affects image transmission to the brain, leading to eye tremors.

5️⃣ Acquired causes after birth

Severe head injury.
Certain neurological diseases or infections.
Oxygen deprivation at birth affecting both brain and eyes.

6️⃣ Unknown causes

In some children, nystagmus appears without a clear reason, recorded as “idiopathic nystagmus.”

Symptoms of Nystagmus in Children and Infants

Nystagmus may not always be noticeable at birth, but these signs should alert parents to consult a pediatric ophthalmologist:

Rapid or shaking eye movements: side-to-side or up-and-down, continuous or intermittent.
Difficulty focusing: trouble looking at the parent or toys.
Poor vision: not reacting to distant or colorful objects like other children.
Head tilt: some children tilt their head to stabilize vision.
Light sensitivity (photophobia): squints or turns away from bright light.
Delayed visual development: slow tracking of moving objects or reaching for toys.
Associated strabismus: sometimes appears due to poor eye movement control.

Types of Nystagmus in Children and Infants

Horizontal Nystagmus – eyes move side-to-side; most common in infants.
Vertical Nystagmus – eyes move up and down; less common, often linked to neurological issues.
Rotary/Spiral Nystagmus – circular eye movement; rare, linked to complex cases or inner ear problems.
Mixed Nystagmus – movement in multiple directions (horizontal + vertical); may indicate nerve or brain issues.
Acquired Nystagmus – appears after birth, related to injury, neurological disease, or eye problems.
Congenital Nystagmus – present from birth or first few months; usually horizontal and can affect focus if untreated.

Stages of Nystagmus in Children and Infants

Stage 1: Infantile Nystagmus

Appears within the first weeks or months.
Usually horizontal; may affect focus on near or distant objects.

Stage 2: Early Acquired Nystagmus

Appears before age 2, often linked to eye problems like cataracts or retinal issues.
Eye movement can be horizontal or vertical.

Stage 3: Late Acquired Nystagmus

Appears after early childhood, sometimes due to neurological disease or injury.
Movement may be horizontal, vertical, or circular; often linked to other complications.

Stage 4: Chronic Nystagmus

Persistent eye movement without treatment.
Can significantly affect focus and vision.
Early intervention is crucial to reduce complications on visual development.

⚠️ Risks of Nystagmus in Children and Infants

Nystagmus is more than abnormal eye movement; it can cause important vision and developmental issues:

1️⃣ Weak or lost vision – difficulty focusing; severe cases may lead to partial or complete vision loss.
2️⃣ Difficulty concentrating and learning – impacts tracking objects, reading, and near vision; may delay visual learning skills.
3️⃣ Psychological and social issues – abnormal eye appearance may cause embarrassment or teasing, affecting confidence.
4️⃣ Strabismus and amblyopia – unequal eye movements may lead to crossed eyes or lazy eye.
5️⃣ Associated complications – nystagmus may result from neurological, hereditary, or congenital eye disorders, requiring comprehensive medical follow-up with pediatric ophthalmologists, neurologists, and visual therapists.

3️⃣ Psychological and Social Issues

An unusual eye appearance can cause embarrassment or teasing.
This may affect the child’s self-confidence and social interaction.

4️⃣ Strabismus and Amblyopia

Unequal eye movements may lead to strabismus (crossed eyes).
The weaker eye may develop lazy eye (Amblyopia), where the brain relies less on it.

5️⃣ Complications Related to Other Conditions

Sometimes, nystagmus is caused by neurological, genetic, or congenital eye disorders.
Comprehensive medical follow-up is essential, involving a pediatric ophthalmologist, neurologist, and visual therapist.

Diagnosis of Nystagmus in Children and Infants

Early diagnosis is crucial to determine the cause and create an appropriate treatment plan:

1️⃣ Clinical Examination

Observing eye movements at rest and during activity.
Measuring direction, speed, and whether it affects one or both eyes.
Checking for associated symptoms such as strabismus or visual impairment.

2️⃣ Visual Acuity Assessment

Age-appropriate tests to evaluate the child’s focus and vision.
Determines if the eyes are partially or severely affected.

3️⃣ Electrodiagnostic Tests

Tests like ERG and VEP assess retinal activity and signal transmission to the brain.
Helps identify whether the nystagmus is congenital or neurological.

4️⃣ Imaging

MRI or CT scans to evaluate the brain and optic nerves.
Detects congenital abnormalities or brain issues linked to nystagmus.

5️⃣ Genetic Tests

Recommended if nystagmus is part of a hereditary syndrome.
Particularly important with family history or additional symptoms like heart or hearing problems.

6️⃣ Monitoring Eye Movement Over Time

Some children show improvement as they grow.
Regular follow-ups help the doctor decide on medical interventions or visual therapy.

Medical Treatment for Nystagmus

Currently, there is no medication that completely cures nystagmus, but certain drugs can reduce symptoms or address associated problems:

1️⃣ Medications to Reduce Eye Movement

Drugs like Baclofen, Gabapentin, Memantine may decrease intensity or speed of eye movements.
Prescribed according to the child’s age and severity, under close supervision by a pediatric ophthalmologist or neurologist.

2️⃣ Medications for Eye-Related Problems

Strabismus: corrective drops or glasses to improve focus.
Inflammation or dryness: lubricating drops or anti-inflammatory medications.

3️⃣ Medications for Weak Vision

Special contact lenses or prescription glasses can improve vision and reduce eye strain, especially in partially weak eyes.

Important Tips:

Always use medications under strict medical supervision.
Continuous monitoring is necessary to assess the effect on eye movement and vision.
Medication is usually part of a comprehensive plan that may include visual exercises or surgery if needed.

Surgical Treatment for Nystagmus

In severe cases or when vision is affected, surgery may be recommended:

1️⃣ Extraocular Muscle Surgery

Adjusts eye muscle tension to reduce nystagmus intensity.
Muscles may be repositioned or length adjusted according to the type of nystagmus.
Improves visual focus but does not completely eliminate nystagmus.

2️⃣ Strabismus Surgery

Corrects eye alignment and coordination.
Reduces visual strain and helps with focus.

3️⃣ Kestenbaum-Anderson Procedure (Head/Eye Position Surgery)

Some children develop abnormal head positions to compensate for nystagmus.
Surgery adjusts muscles to stabilize the eyes for better natural visual alignment.

Post-Surgery Tips:

Regular follow-up with a pediatric ophthalmologist.
Some children may need adjustments or additional surgeries as they grow.
Surgery is part of a comprehensive treatment plan including visual therapy and medications.
Goal: improve vision, reduce eye movement, and enhance daily life.

Exercises for Nystagmus in Children and Infants

Exercises do not completely stop nystagmus, but they help:

Improve eye focus.
Strengthen eye muscles and movement.
Reduce visual fatigue.
Enhance visual balance and coordination.

1️⃣ Tracking Exercise

Use a toy or light moving slowly in all directions.
Encourage the child to follow it with their eyes.
Repeat 5–10 times daily.
Purpose: train the eyes to control movement and strengthen muscles.

2️⃣ Near-Far Focus Exercise

Have the child focus on a near object (toy) for 10 seconds, then a far object (picture on the wall).
Repeat 5–10 times daily.
Purpose: improve the ability to switch focus quickly and reduce eye wobbling.

3️⃣ Patch Therapy

For cases with one weak eye, cover the stronger eye for specific periods (doctor-guided).
Purpose: force the weaker eye to work and improve function.

4️⃣ Magnifying Lens Focus Exercise

Use a magnifying glass or picture books with small details.
Purpose: enhance visual performance and eye focus.

5️⃣ Visual-Motor Coordination Exercises

Activities like gently throwing a ball, stacking blocks, maze games, or drawing on a large sheet.
Purpose: coordinate eye movement with body and improve visual balance.

⚠️ Important Notes:

Exercises complement treatment; they do not replace surgery or medication.
Should be done under supervision of a pediatric ophthalmologist or visual therapist.
Consistency is more important than the number of repetitions.
Goal: improve eye performance and reduce fatigue, not eliminate nystagmus entirely.

Parental Tips for Managing Nystagmus

Proper management and support help children live normal lives:

1️⃣ Regular Medical Follow-Up

Routine visits with a pediatric ophthalmologist.
In complex cases, consultation with neurologists or genetic specialists may be needed.

2️⃣ Adherence to Treatment

Administer medications, eye drops, or special glasses exactly as prescribed.

3️⃣ Early Intervention

The earlier treatment begins, the better the outcomes:
- Improved vision.
- Reduced nystagmus intensity.
- Normal eye and facial development.

4️⃣ Psychological Support

Reassure and encourage the child.
Prevent bullying or negative comments from others.
Consider psychological sessions if the child feels frustrated or anxious.

5️⃣ Eye Care and Environment

Provide appropriate lighting in areas where the child spends time.
Avoid prolonged visual strain, especially in older children.
Offer activities that strengthen visual focus without fatigue.

6️⃣ Prepare for Growth-Related Changes

Some children may need adjustments to glasses or exercises as they grow.
Nystagmus may improve or change over time; regular monitoring helps modify treatment plans.

7️⃣ Complementary Visual Exercises