Abstract

Nystagmus often causes decreased visual acuity as a direct result of the inability to maintain stable foveal vision. The eye movements themselves do not require treatment if the patient is asymptomatic. However, therapy is necessary if visual disability is present. Treatments are included pharmacologic treatment, optical devices, and operation. There are few controlled treatment trials for therapeutic efficacy. Recently, treatment with 3, 4-diaminopyridine and 4-aminopyridine have been shown to be effective for downbeat and upbeat nystagmus. Gabapentin, baclofen, and clonazepam also are useful in 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 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.