Have you experienced your eyes rolling back or uncontrolled eye movement? Either one can be a frightening experience, but knowing the underlying cause of your eye condition can help you reduce the frequency and intensity of your symptoms.
What Causes Eye Rolling or Uncontrolled Eye Movement?
Eye rolling or uncontrolled eye movement, or nystagmus, is usually caused by an abnormal function in the part of the inner ear (the labyrinth) or brain that regulates eye movement. The labyrinth helps you sense position and movement.
What Is Nystagmus?
Nystagmus is a condition that results in the eyes making uncontrolled or repetitive movements. It is often accompanied by vision or proprioceptive problems. You may also experience blurry vision and trouble focusing. These movements can happen in one or both eyes, and you may also notice issues with balance. Stress or fatigue can worsen your symptoms.
Types of nystagmus
There are two types of nystagmus:
- Congenital nystagmus: Also called infantile nystagmus syndrome, symptoms typically appear in newborns or babies between six weeks and three months after birth. The specific cause is unknown, but physicians suspect there may be a genetic component. Congenital nystagmus usually occurs in both eyes, and blurry vision is a common symptom in older children.
- Acquired nystagmus: Acquired nystagmus is nystagmus that develops any time post-early childhood. It may be a sign of an underlying condition, such as a problem with your middle ear, stroke, head injury, or a medication side effect.
Causes of Nystagmus
The causes of nystagmus can range from minor problems with your inner ear to being a sign of another underlying medical issue. Some common causes include:
- Inner ear issues
- Head injuries
- Drug/alcohol use
- Diseases such as multiple sclerosis
- Eye problems, such as strabismus
- Ocular albinism
- Certain medications, such as lithium
Symptoms of Nystagmus
Other symptoms can include the following:
- Eyes moving side to side
- Rapid involuntary eye movement
- Eyes rolling back
- Eye motion that changes pace
- Eyes rolling up
- Nodding the head or holding it in odd positions to help eyes focus
- Eyes moving in circles
- Symptoms worsening when the head is turned
Diagnosing Uncontrolled Eye Movement
When diagnosing uncontrolled eye movements, I first perform a thorough physical exam, focusing on the inner ear and nervous system, and take down a complete medical history. If I suspect that a patient has nystagmus, I may refer them to an opthamologist or a neurologist, depending on the initial exam and associated symptoms. Additional testing may include:
- Neurological exam
- Ear exam
- Eye exam with specialized equipment called a “slit lamp”
- CT of the brain
- MRI of the brain
One common test to check nystagmus involves spinning a person in circles for approximately 30 seconds, and then stopping and asking them to stare at an object. If nystagmus is present, their eyes will slowly move in one direction before quickly moving the opposite way.
These tests can check to see how the eyes are functioning, and other underlying causes that might be the problem.
In congenital nystagmus, brinzolamide eye drops may help alleviate symptoms. Always check the expiration dates on medications, and be sure to never use expired eye drops or to share eye drops with others, as this may expose you to infection.
Treatments for acquired nystagmus will differ depending on the underlying condition. In some situations, nystagmus gets better on its own over time, while other times it will go away once the root cause is addressed. Certain medications can ease eye rolling symptoms in adults such as baclofen (Lioresal), a muscle relaxant, and onabotulinumtoxina (Botox).
Though not used routinely, surgery can be done to reposition the eye muscles. It isn’t a cure, but it can help reduce the amount that an individual needs to turn their head to see better.
Acupuncture has also been shown to help improve visual function in nystagmus.
What You Can Do at Home
Wearing specialized contacts or glasses can sometimes improve visual problems due to nystagmus, as can good lighting, reading large-print books (or increasing the print size on your phone or tablet), or using a magnifying device.
Engaging in activities that promote calmness and relaxation, such as meditation, can also help. With both types of nystagmus, the more generally relaxed a person is, the less severe their symptoms.
Related Conditions and Risk Factors
Conditions related to nystagmus include:
- Cataracts: Nystagmus is common in people with cataracts.
- Strabismus: Strabismus is another eye muscle disorder caused by a misalignment of the eyes. It can result in esotropia, an inward turning of the eyes, and hypertropia or hypotropia, which are both types of vertical misalignment.
- Ménière’s disease: Ménière’s disease is a disorder of the inner ear that causes vertigo, and in severe cases can also be associated with nystagmus.
- Orthostatic hypotension: Orthostatic hypotension is when blood pressure rapidly decreases upon standing up quickly. This is usually due to dehydration, and nystagmus is sometimes present.
- Seizures: Some seizures present with uncontrolled eye movements that can appear to be similar to nystagmus. The eyes may roll upward or sideways in a Petit Mal seizure, and tonic-clonic seizures often involve rhythmic eye movements or the eyes rolling backwards.
Risk factors for nystagmus are if you:
- Have a deficiency of thiamine or B-12
- Had a stroke, brain tumor, or head injury
- Have a nervous system disorder
- Take certain medications i.e. antiseizure medications
- Have a family history of nystagmus
When to See a Doctor
Acquired nystagmus is often caused by an underlying medical condition, so you should see a doctor as soon as possible for further evaluation and to initiate appropriate treatment.
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