Revision as of 13:27, 18 January 2017 by Rossdonaldson1 (talk | contribs) (Evaluation)


  • The semicircular canals of the vestibules and the extraocular muscles of the eye function together physiologically to help control gaze locked when the head is in motion
  • Nystagmus is an aberration in this stabilization of the ocular muscles when in motion

Clinical Features

  • Rapid, uncontrolled, rhythmic oscillation of the eye
  • May be horizontal, vertical, and/or rotary

Differential Diagnosis

Congenital Nystagmus

  • Optic Nerve Hypoplasia
  • Macular Disease

Acquired Nystagmus


"H in space" Test

  • Trace H in space

Caloric Reflex Test (also known as Vestibular Caloric Stimulation)

  • The best clinical test for the Vestibulo-Optic reflex
  • Water irrigated into the external auditory canal will exaggerate nystagmus if present
  • Temperature of the irrigated water will control the direction.
    • Cold water will exaggerate a nystagmus to move contralaterally
    • Warm water will exaggerate a nystagmus to move ipsilaterally

COWS: Cold Opposite, Warm Same.


Stabilize patient and manage primary course of illness. If possible, reverse toxicology.


See Also

External Links