Zusammenfassung
Nystagmus ist definiert als unwillkürliche, periodische Bewegung, bei der eines oder
beide Augen vom Fixationspunkt wegdriften (sog. Drift). Auf die Drift, die langsame
Phase, folgt entweder eine schnelle, refixierende Bewegung (sog. Refixationssakkade
oder schnelle Phase) oder eine langsamere Bewegung zur Wiederaufnahme der Fixation.
In dieser Übersichtsarbeit sollen die wichtigsten Formen von Nystagmus bei Kindern
erörtert werden, für eine Übersicht bei Erwachsenen sei auf [1] verwiesen.
Abstract
Nystagmus describes an involuntary, periodic movement of one or both eyes. About 1/600
children and adolescents have nystagmus, most of them idiopathic infantile nystagmus
(IIN), also called “congenital nystagmus”, which can be caused by mutations in the
FRMD7 gene. Other frequent forms of nystagmus are latent nystagmus, which is usually associated
with infantile strabismus, and nystagmus associated with albinism. Sometimes difficult
to distinguish in young infants is a sensory nystagmus, where a defect in the visual
system reduces vision and causes nystagmus. Causes include retinal dystrophies, congenital
stationary night blindness and structural ocular defects including optic nerve hypoplasia
or dense bilateral congenital cataracts. Unilateral nystagmus can be the sign of an
anterior visual pathway lesion. Seesaw nystagmus may be associated with suprasellar
and mesodiencephalic lesions and – rarely – with retinal dystrophies.
The ophthalmology plays a key role in identifying the form of nystagmus. Children
with new onset nystagmus, with spasmus nutans, with vertical or unilateral nystagmus
and those with seesaw nystagmus require neurologic evaluation including imaging of
the brain.
The treatment of nystagmus depends on the underlying cause. Even minor refractive
errors should be corrected, contact lenses offer advantages over glasses.
Gabapentin and memantine, possibly also carbonic anhydrase inhibitors, are effective
in treating IIN, nystagmus in albinism and sensory nystagmus. Nevertheless, pharmacologic
treatment of nystagmus is rarely used in children; the reasons are the limited effects
on vision, the need for lifelong therapy, and potential side effects. Eye muscle surgery
(Anderson procedure, Kestenbaum procedure) can correct a nystagmus-related anomalous
head posture. The concept of “artifical divergence” of Cüppers may help to decrease
nystagmus intensity in patients whose nystagmus dampens with convergence. The four-muscle-tenotomy,
which involves disinsertion and reinsertion of the horizontal muscles at the original
insertion of both eyes, has a proven but limited positive effect on visual acuity.
Schlüsselwörter
Nystagmus - Kind - Diagnose - Therapie - ophthalmologische Chirurgie - Kopfzwangshaltung
Key words
nystagmus - child - diagnosis - therapy - eye surgery - anomalous head posture
