SymptomEyes & vision
Nystagmus (Involuntary Eye Movements)
Nystagmus is a repetitive, involuntary movement of the eyes, side to side, up and down or in a circle, sometimes described as dancing or jiggling eyes. New nystagmus in adults is most often caused by an inner ear problem such as BPPV or vestibular neuritis, usually with spinning vertigo. It can also signal a stroke, multiple sclerosis, medicines or alcohol. Sudden nystagmus with dizziness, double vision or trouble walking needs emergency assessment.
Also called: Involuntary eye movements, dancing eyes, jiggling eyes, shaky eyes, wobbly eyes
At a glance
- What it is
- Rhythmic, involuntary eye movements, usually a slow drift then a fast correcting jerk.
- New in adults
- Usually an inner ear disorder (BPPV, vestibular neuritis, Meniere's). Less often stroke, MS, drugs or alcohol.
- Present from infancy
- Infantile nystagmus, often with albinism, cataract or other eye conditions.
- Common symptoms with it
- Vertigo, nausea, imbalance, blurry or bouncing vision (oscillopsia).
- Red flags
- Sudden onset with headache, double vision, slurred speech, numbness, weakness or inability to walk.
When to get help
Call 911 or go to the ER
- Sudden nystagmus or dizziness with double vision, slurred speech, facial droop, numbness, weakness or clumsiness of a limb
- New nystagmus with a severe headache, inability to stand or walk unaided, or after a head injury
- Nystagmus with confusion, unsteady walking and recent heavy drinking or severe vomiting (possible Wernicke encephalopathy)
- New nystagmus after a possible overdose
See a doctor within a day or two
- Continuous spinning vertigo with nystagmus lasting more than a day, even if you can walk
- Nystagmus with sudden hearing loss or ringing in one ear
- A baby whose eyes wobble or who does not seem to fix on faces by 2 to 3 months
Book a routine appointment
- Brief spinning episodes when turning over in bed or looking up
- Long-standing nystagmus that has changed or worsened
- Bouncing or jumping vision without dizziness
What nystagmus looks like
In the most common type, jerk nystagmus, the eyes slowly drift in one direction and then flick back quickly. Doctors name the direction by the fast flick, for example "left-beating". In pendular nystagmus, the eyes swing back and forth at equal speeds, more typical of nystagmus present from infancy.
Movements can be:
- horizontal (side to side), the most common
- vertical (up-beating or down-beating)
- torsional (rotating)
- mixed
People with new nystagmus often notice oscillopsia, a feeling that the world is bouncing or moving. People born with nystagmus usually do not see this, because their brain has adapted.
Common causes with dizziness or vertigo
| Cause | Typical story | Type of nystagmus |
|---|---|---|
| BPPV | Spinning for under a minute when lying down, rolling over or looking up | Brief torsional-upbeat nystagmus triggered by position |
| Vestibular neuritis | Sudden severe vertigo for days after a cold, no hearing loss | Constant horizontal, beating away from the affected ear |
| Labyrinthitis | As above, with hearing loss | Similar to vestibular neuritis |
| Meniere's disease | Attacks of vertigo lasting 20 minutes to hours, with ear fullness, ringing and hearing loss | During attacks only |
| Vestibular migraine | Vertigo with or without headache, motion sensitivity, migraine history | Variable |
Serious causes
- Stroke in the brainstem or cerebellum: can mimic an inner ear problem. Clues include nystagmus that changes direction with gaze, purely vertical nystagmus, skew (one eye higher), severe imbalance, headache and other neurological signs. Emergency doctors use a bedside exam called HINTS to tell the two apart.
- Multiple sclerosis: can cause nystagmus and a specific pattern called internuclear ophthalmoplegia.
- Medicines and toxins: alcohol, anti-seizure medicines (phenytoin, carbamazepine), lithium, sedatives and ketamine.
- Wernicke encephalopathy: thiamine deficiency with confusion and unsteady gait.
- Chiari malformation and brain tumors: down-beating nystagmus is a classic sign of problems where the brain meets the spinal cord.
- Head injury.
Nystagmus present from early childhood
Infantile nystagmus usually appears in the first 6 months. It may be linked to albinism, congenital cataracts, optic nerve or retinal problems, or have no other cause found (idiopathic). These children need a full eye exam by a pediatric ophthalmologist. See nystagmus for types and treatment.
Normal (physiologic) nystagmus
Some nystagmus is normal:
- a few beats when looking far to the side (end-point nystagmus)
- when watching a moving train or scenery (optokinetic nystagmus)
- after spinning around
Abnormal eye movements that are not nystagmus
Not every abnormal spontaneous eye movement is nystagmus. Others include:
| Movement | What it looks like | Common causes |
|---|---|---|
| Eyelid twitching (myokymia) | Flickering of the lid, not the eye | Fatigue, caffeine, stress. Harmless |
| Square-wave jerks | Small jumps away and back with a pause | Normal in small amounts. Increased in some neurological diseases |
| Ocular flutter and opsoclonus | Rapid chaotic bursts without slow drift, "dancing eyes" | Infection, paraneoplastic syndromes, neuroblastoma in children. Needs urgent assessment |
| Superior oblique myokymia | Brief shimmering of vision in one eye | Usually benign nerve irritation |
| Spasmus nutans | Nystagmus with head nodding and tilt in a toddler | Usually resolves. Needs scan to exclude tumor |
How doctors examine nystagmus
The doctor watches your eyes looking straight ahead and to each side, may use special goggles (Frenzel lenses or video goggles) that stop you focusing, and performs positional tests such as the Dix-Hallpike maneuver for BPPV. They check hearing, coordination, walking and other cranial nerves. Depending on findings, tests may include MRI of the brain, hearing tests, videonystagmography (VNG) and blood tests.
Treatment
Treatment targets the cause:
- BPPV: repositioning maneuvers such as the Epley maneuver, often curing it in one or two sessions
- Vestibular neuritis: short-term anti-nausea medicine, sometimes steroids, and vestibular rehabilitation exercises
- Stroke: emergency stroke care
- Medicines or alcohol: adjusting doses, thiamine for Wernicke encephalopathy
- Long-standing nystagmus: glasses or contact lenses, certain medicines, and sometimes eye muscle surgery
Frequently asked questions
What causes nystagmus in adults?
The most common causes of new nystagmus in adults are inner ear problems such as BPPV, vestibular neuritis and Meniere's disease. Other causes include stroke, multiple sclerosis, head injury, alcohol, anti-seizure medicines and thiamine deficiency. Sudden nystagmus with neurological symptoms needs emergency care.
Is nystagmus a sign of a stroke?
It can be. Nystagmus from a stroke in the brainstem or cerebellum often comes with severe imbalance, double vision, slurred speech, numbness or headache, and may change direction depending on where you look. Because it can mimic an ear problem, sudden vertigo with nystagmus should be assessed urgently.
Can anxiety cause nystagmus?
Anxiety does not cause true nystagmus, although it can cause dizziness and eyelid twitching. If someone sees your eyes jerking, there is usually a vestibular, neurological, medication or inherited cause that a doctor can identify.
Does nystagmus go away?
Nystagmus from BPPV, vestibular neuritis, alcohol or medicines usually resolves as the cause is treated. Infantile nystagmus is usually lifelong but often lessens with age. Nystagmus from stroke or MS may improve partly.
What abnormal eye movements are not nystagmus?
Eyelid twitching, square-wave jerks, ocular flutter, opsoclonus and superior oblique myokymia can look similar but are not nystagmus. Unlike nystagmus, most lack the rhythmic slow drift and fast correction. Opsoclonus, with chaotic darting eye movements, needs urgent medical review.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Ophthalmology: Nystagmus
- American Association for Pediatric Ophthalmology and Strabismus: Nystagmus
- MedlinePlus: Nystagmus
- American Academy of Neurology / American Academy of Otolaryngology: Clinical practice guideline for benign paroxysmal positional vertigo
- NHS: Nystagmus