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  • Nystagmus = involuntary eye movement
  • 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
  • Noonan syndrome

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 cause of illness.


See Also

External Links