Acquired Nystagmus

Well I am 18 years old and have discovered about a month ago, a condition in where my field of vision would "shiver" rapidly for a few seconds.  Wondering what this was I went to an Ophthalmologist who diagnosed this as "Superior Oblique Myokymia (SOM)" and told me that a specialist-friend was coming in and told me to return on the weekend.  On my return visit the specialist held a card and moved it far left and right and up and down and said that i had "horizontal gaze evoked nystagmus" but said that it was most likely benign because it was not the vertical type.  I also inquired why the nystagmus also occurs spontaneously on my frontal view (such as when looking directly in front of you) and he said that it was unknown, but to make sure it was benign, I would have to come in for a Visual Field Test.  My results came out normal, but at this time, I also noted that i was ever so slightly off balance.  The Ophthalmologist suggested no further action but I went to a Neurologist who suggested an MRI.  The results came back completely normal, with no MS or tumors in the labyrinth.  He then said it was a mild labyrinthine infection and prescribed Antivert (Meclizine) for 2 months. The nystagmus did seem to reduce its frequency and the off-balanceness also became less apparent, but my concern now is...when will it stop altogether? How long can a labyrinthine infection last?

[Neuro Forum]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.

Nystagmus can have many causes. One is superior oblique myokymia; I am unclear as to whether or not you actually ended up receiving that diagnosis, but I will provide you some information about it anywyay. The exact cause of superior oblique myokymia is not known but it is in part due to intermittent contraction of the superior oblique muscle, one of the eye muscles. In normal adult patients it can come and go over the span of their life. It has been associated with other more serious conditions (lead toxicity and vascular anomalies to name a few), but an MRI of the brain that is normal makes these less likely.

Nystagmus can have other causes, many of which are ruled out with a normal MRI of the brain. Inner ear problems such as labrynthitis can certainly lead to nystagmus, as well as vertigo. This improves with time, usually over a few weeks, but medications such as Antivert can suppress the inner ear from readjusting, leading to a more prolonged period of symptoms. Sometimes, a specific type of physical therapy called vestibular rehab can help in helping your inner ears adjust.

In general, nystagmus can be from the eye, the brain, or the inner ear. A neuro-opthalmologist is the most appropriate person to evaluate nystagmus coming from the ear, and an ENT specialist, or sometimes a neuro-otologist, is best to evaluate and treat nystagmus coming from the inner ear. Therefore, depending on what your exact diagnosis is, evaluation by a neuro-opthalmologist or ENT (or neuro-otologist, depending on what is available in your area) would be of benefit to you, with vestibular rehab if your off-balance sensation is deemed to be due to inner ear problems.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.