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. 2002 Jun;86(6):670-5.
doi: 10.1136/bjo.86.6.670.

Clinical and ocular motor analysis of the infantile nystagmus syndrome in the first 6 months of life

R W Hertle  1 , V K Maldanado, M Maybodi, D Yang
Affiliations

Clinical and ocular motor analysis of the infantile nystagmus syndrome in the first 6 months of life

R W Hertle et al. Br J Ophthalmol. 2002 Jun.

Abstract

Background/aims: The infantile nystagmus syndrome (INS) usually begins in infancy and may or may not be associated with visual sensory system abnormalities. Little is known about its specific waveforms in the first 6 months of life or their relation to the developing visual system. This study identifies the clinical and ocular motility characteristics of the INS and establishes the range of waveforms present in the first 6 months of life.

Methods: 27 infants with involuntary ocular oscillations typical of INS are included in this analysis. They were evaluated both clinically and with motility recordings. Eye movement analysis was performed off line from computer analysis of digitised data. Variables analysed included age, sex, vision, ocular abnormalities, head position, and null zone, neutral zone characteristics, symmetry, conjugacy, waveforms, frequencies, and foveation times.

Results: Ages ranged from 3 to 6.5 months (average 4.9 months). 15 patients (56%) had abnormal vision for age, nine (33%) had strabismus, five (19%) had an anomalous head posture, 13 (48%) had oculographic null and neutral positions, nine (33%) had binocular asymmetry, and only two showed consistent dysconjugacy. Average binocular frequency was 3.3 Hz, monocular frequency 6.6 Hz. Average foveation periods were longer and more "jerk" wave forms were observed in those patients with normal vision.

Conclusions: Common clinical characteristics and eye movement waveforms of INS begin in the first few months of infancy and waveform analysis at this time may help with both diagnosis and visual status.

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Figures

Figure 1
Figure 1
The percentage of patients exhibiting individual waveforms at any time during ocular motility recordings. A high percentage of patients displayed the more developed waveforms of jerk and jerk with extended foveation. (P = pendular, AP = asymmetric pendular, J = jerk, Jef = jerk with extended foveation, DJ/BDJ = dual jerk/bidirectional jerk.)
Figure 2
Figure 2
The percentage of patients exhibiting individual waveforms at any time during ocular motility recordings comparing those patients with normal vision for age to those with abnormal vision for age. The more developed waveforms of J, Jef, and DJ/BDJ are present in a higher percentage of patients with normal vision. (P = pendular, AP = asymmetric pendular, J = jerk, Jef = jerk with extended foveation, DJ/BDJ = dual jerk/bidirectional jerk.)
Figure 3
Figure 3
This is a typical 15 second period of ocular motor recordings from a patient with INS and no known sensory system deficit (patient No 3). This shows gaze between 0 degrees and right 15 degrees with periods of jerk left with extended foveation at 0 degrees, switching to jerk right with extended foveation at right 15 degrees. This indicates a null/neutral zone between 0 and 15 degrees of right gaze. (EF = extended foveation, R = rightward eye movements and right gaze, L = leftward eye movements and left gaze). ••, Extended foveation periods of during the slow phase of the oscillation.
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