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Case of the week 51 ( April 2012 )
Monocular Nystagmus

The mother of this 10 months old infant noted that the right eye of her baby is dancing all the time . She noticed that shortly after birth . No history of delivery troubles , the baby looks fine with no apparent neurological or any other disorders

 See video of this patient



Causes of Monocular Nystagmus in infancy and early childhood

 (  Farmer J, Hoyt CS. Monocular nystagmus in infancy and early childhood. Am J Ophthalmol 1984; 98:504-509. )

    1. Horizontal

  A. Lesions of optic nerve, chiasm, midbrain, or brainstem

  B. Nervous system disease, such as epidemic meningitis, and congenital syphilis

  C. Seizures

  D. Superior oblique myokymia-benign, intermittent, uniocular

  E. Spasmus nutans

  F. Tumors of brainstem

  G. Unilateral amblyopia

  H. Unilateral astigmatism or high refractive error

  I. Unilateral opacity of the ocular media

    2. Vertical

  A. Myokymia of lower eyelid

  B. Sleep

  C. Spasmus nutans

  D. Unilateral amblyopia (the Heimann–Bielschowsky phenomenon).


Although monocular nystagmus, is usually considered as a benign entity, it may be associated with any of the above serious conditions. These anomalies occur infrequently but I used to advise neuroimaging in each case.

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