Eye shaking

[Tiffne]

My daughter (who is now 14 months old) right eye shakes from side to side when focusing on something. What is causing this and is it fixable?

A little back story...

We first went to the eye doctor in 3/2016  due to a clogged duct in her left eye and what seems as if her eyes were crossing. A few days before that appointment the duct cleared up and we were told the 'crossing' wasn't actually crossing (forget the word he used to call it) it just appeared to be due to her nose bridge.

On 6/27/2016 , we went back to the eye doctor because I noticed she would turn her head when looking at things (ie. toys, food, etc) and also I seen her right eye shake maybe 3 times over that last month for maybe a few seconds at a time. She was diagnosed with benign torticollis (if im spelling it right) and was told "he wasn't too worried" about either issues.

Today, 8/5/2016, she still turns her head and now the right eye shakes every time she focuses on something and lasts until she stops looking at it. This has been happening for a few weeks now.

Given the short amount of time and how much it has progressed, what comes to your mind as possible reasons of what is causing this?

If it helps anything, she is a twin and was born at 36weeks due to her being IUGR ( interuterine growth restricted)

[Tiffne]

We have been meeting with a pediactic opthalmologist. We do have an appointment for Monday to get her checked out with him again. Im just worried that it could be something serious and its very hard waiting for monday without a clue as to what this may be. Ive been googling and ive found nystagmus but it is only in one eye and not all the time. The videos ive seen are kind of slow compared to how fast her eye moves. Ive also seen something about neuro disorder. Do you know what kind of tests will be done when we go see him Monday?

[JohnHaganMD]

I doubt waiting until Monday will create a problem. I do not know what tests might be done.  Make a list of questions and don't leave until they have been answered.

[Tiffne]

Update: We finally met with the neuro-opthalmologist. Two pages of questions and not one got a real answer. He said her astigmatism has gotten a bit worse and is now far-sighted but he doesn't recommend glasses yet. I don't understand why she doesn't need glasses if her eye are obviously getting worse? Even if they aren't 'bad' enough to need them now, its obviously showing a decrease in her vision. Shouldn't that be a red flag?

As for the nystagmus, the only info I got was that he didn't believe it to be a neurological problem. He mentioned it could be something to do with how the eyes come together when looking at something. It started with a 'C' but I cant remember what it was. Do you know what that is?  

[JohnHaganMD]

Probably "convergence"    Most children are farsighted, many have some astigmatism. As long as the amounts are small and approximately equal in the two eyes most children do not develop amblyopia or strabismus.  Given the work up your child has had likely the best course is to continue follow up with the pediatric and neuro-ophthalmologists and report any new symptoms.

[Tiffne]

Yes, that is what he called it, thank you! Does this mean her eyes will always shake when focusing?

[JohnHaganMD]

No the converging (moving the eyes inward to read or see near objects) has to develop like the rest of the body. It stabilizes as we get older so she may outgrown the jiggling

[Tiffne]

Thank you! I really hope so. Do you know if she sees whatever she's looking at shaking? Is there any exercises that I can do with her that will help?

I came across something called Convergence-evoked Nystagmus. It describes hers to a T. It said with acquired its found to be due to multiple sclerosis. From my understanding, MS is usually seen with patients quite older than her. Is there anything I should be on the look out for as far as that?

[JohnHaganMD]

That is highly unlikely. No exercises will help. Some children suppress a second image and moving while others see double or jerking. Believe MS is not a consideration and far more likely due to development of binocular vision or a variant of pediatric strabismus

[Tiffne]

Ok, thank you again!

[JohnHaganMD]

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[Tiffne]

Update: We finally met with the neuro-opthalmologist. Two pages of questions and not one got a real answer. He said her astigmatism has gotten a bit worse and is now far-sighted but he doesn't recommend glasses yet. I don't understand why she doesn't need glasses if her eye are obviously getting worse? Even if they aren't 'bad' enough to need them now, its obviously showing a decrease in her vision. Shouldn't that be a red flag?

As for the nystagmus, the only info I got was that he didn't believe it to be a neurological problem. He mentioned it could be something to do with how the eyes come together when looking at something. It started with a 'C' but I cant remember what it was. Do you know what that is?  

[Tiffne]

Update: Blood work came back good except her white blood cells were high. They think she was possibly fighting an infection (although she wasn't sick) and have ordered a repeat test to be done in 2 weeks. Not that I want her sugar levels to be bad, but I was hoping that was the cause to her 'shaking' as it seems to me as a easy fix. Her EEG came back normal but due to her symptoms only happening when she first wakes up after a full nights rest, we have set up a 24-hour EEG to be done on Nov. 17th.

Now that low blood sugar has been ruled out, I cant help but think the tremors and the nystagmus is related somehow.

[JohnHaganMD]

Quite possibly  hope all turns out well

[Tiffne]

Just want to update.. After speaking with the pediatrician, we were referred to a Neurologist for the shaking (tremors is what they called it). The neurologist suggested getting some blood work done as well as an EEG which we have scheduled for the 20th. Ill update again after we get the results. Thanks again for your help!

[JohnHaganMD]

Thank you and good luck

[JohnHaganMD]

I would get a second opinion from a different pediatric ophthalmologist Eye MD. The "shaking" is not normal.  

[Tiffne]

I have an appointment with a new pediatric neuro opthalomologist in November. What I meant in my previous question was that her body shakes. I plan to call her pediatrician Monday to ask if she needs to be seen sooner than her check up on 10/17 but was wondering if you knew if it could possibly be a symptom of the nystagmus?

[JohnHaganMD]

Most children with nystagmus do not have body shaking unless they have a neurological syndrome associated with different cause of body shaking. Calling the pediatrician is a good idea.

[Tiffne]

So ive noticed that when my daughter wake up every morning, she is very shakey. It doesn't happen when she wakes up from her naps and gets better usually after breakfast. Its been happening since a little after she first got the diagnoses of Nystagmus. Do you know if this symptom has something to do with the Nystagmus?

[JohnHaganMD]

Okay. Let us know what the neuroophthalmologist says.

[Tiffne]

Correction: pendular gaze-evoked acquired nystagmus when near *

[Tiffne]

So i've spoke with the ophthalmologist again. He said there wasn't any signs of macular hypoplasia, congential cataracts, or ocular albinism. That her eyes are healthy. He also said that he doesn't know the type but it is pendular gaze-evoked acquired nystagmus. He has referred us to a neuro-opthalmologist and we have an appointment on November 9th. I will update as I get more information incase anyone comes across this with the same issues.

[JohnHaganMD]

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[Tiffne]

Okay, will do. Thank you.

[JohnHaganMD]

Many cases of nystagmus occur only when looking to the extreme left or right and is called "end point nystagmus"  it often is benign and not associated with  poor vision or neurological problems. You might ask what type she has.

[Tiffne]

Thank you, I will ask about those things. He did mention she had a slight astigmastim in her right eye, but not significant enough to prescribe glasses. Also, he found the nystagmus was actually in both eyes but was more profound in the right eye. I still haven't noticed the nystagmus in the left eye. Could the slight astigmastim in the right eye be causing the shaking?

[JohnHaganMD]

I would ask the pediatric ophthalmologist to refer you to a neuro-ophthalmologist for another opinion.  Nystagmus is often associated with reduced vision ask about the health of each eye and whether there is any evidence of macular hypoplasia, congentical cataracts, ocular albanism, etc.

[Tiffne]

We've gotten the results to the MRI back. Her brain shows no issues whatsoever. Her doctor said there are no other tests to perform and she will need to learn to adapt with her eyes. That sometimes they don't ever find a cause for the nystagmus. I am happy with the results of the MRI but I cant help but want an answer as to why. Would you suggest I get a referral for a neurologist just to double check all is well?

[Tiffne]

She was diagnosed with acquired nystagmus and we are having an MRI done on her brain tomorrow. Depending those results, will we see a neurologist.

[JohnHaganMD]

Glad you are getting a proper work up and I hope all turns out well.  For the sake of others that end up reading your posts please consider posting when the testing is complete and you have the results.  

[Tiffne]

Okay, thank you for your help! Our appointment is this afternoon so ill update when we find something out.

[JohnHaganMD]

Good luck

[Tiffne]

Those are all very good questions, thank you. I feel as if how could she have any of those things if the ophthalmologist hasn't mentioned seeing it before. Are those things something that could develop over time?  

[JohnHaganMD]

Yes and you have to ask specific questions so that you don't leave with doubts or unanswered questions.

[Tiffne]

I don't even know what questions to ask. I just want an answer as to what it is and how to fix it.

[JohnHaganMD]

1. Does she have nystagmus  2. Does she have an eye muscle problem (strabismus) 3. Does she have amlyopia (poor vision not improved with glasses  4. Does she need glasses 5. What is her vision in each eye. 6.
Does she need to see an orthopedic surgery for the neck problem? 7. Are you comfortable with all these problems? Do you need a second opinion? 8. Are there any special tests needed like MRI or CT?  9 When do you need to see her next.  10. I need some reassurance what can you tell me that will make me feel more comfortable?