The sub-clinical see-saw nystagmus embedded in infantile nystagmus

Vision Res. 2007 Feb;47(3):393-401. doi: 10.1016/j.visres.2006.09.001. Epub 2006 Oct 11.

Abstract

A transient, decompensated vertical phoria in an individual with infantile nystagmus syndrome (INS) resulted in two images that oscillated vertically-a diplopic oscillopsia. Ocular motor studies during the vertical oscillopsia recreated by vertical prisms, led to the identification of a sub-clinical see-saw nystagmus (SSN), present under the prism-induced diplopic condition. Retrospective analysis of ocular motor recordings made prior to the above episode of vertical diplopia revealed the presence of that same sub-clinical SSN. The SSN had not been detected previously despite extensive observations and recordings of this subject's pendular IN over a period of forty years. Three- dimensional search-coil data from fourteen additional INS subjects (with pendular and jerk waveforms) confirmed the existence of sub-clinical SSN embedded within the clinically detectable horizontal-torsional IN in seven of the fifteen and a sub-clinical, conjugate, vertical component in the remaining eight. Unlike the clinically visible SSN found in achiasma, the cause of this sub-clinical SSN is hypothesized to be due to a failure of the forces of the oblique muscles (responsible for the torsional component of the IN) to balance out the associated forces of the vertical recti; the net result is a small, sub-clinical SSN. Thus, so-called "horizontal" IN is actually a horizontal-torsional oscillation with a secondary, sub-clinical SSN or conjugate vertical component. The suppression of oscillopsia by efference copy in INS appears to be accomplished for each eye individually, even in a binocular individual. However, failure to fuse the two images results in oscillopsia of one of them.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Diplopia / etiology*
  • Eye Movement Measurements
  • Eye Movements
  • Fixation, Ocular
  • Humans
  • Male
  • Middle Aged
  • Nystagmus, Congenital / complications
  • Nystagmus, Congenital / physiopathology
  • Nystagmus, Pathologic / complications*
  • Nystagmus, Pathologic / physiopathology
  • Prospective Studies
  • Retrospective Studies
  • Torsion Abnormality / etiology