Management of nystagmus by surgery and botulinum toxin options: a review

Aim: To critically evaluate the literature in order to explore the success of botulinum toxin and extraocular muscle surgery in the management of acquired nystagmus. Methods: A literature search was undertaken using the PubMed and Web of Knowledge databases. Only studies reported in English were included. Results: The aim of using botulinum toxin is to alleviate the symptoms induced by acquired nystagmus. The major problematic symptoms are oscillopsia, reduced visual acuity and abnormal head posture. An injection of botulinum toxin into the retrobulbar space is beneficial if the acquired nystagmus has horizontal, vertical and torsional components, whereas if the nystagmus is purely horizontal an injection of botulinum toxin into the horizontal rectus muscles appears to be the better option. Surgery is aimed at alleviating the symptoms induced by acquired nystagmus. Extraocular muscle surgery is of value in the management of acquired nystagmus, particularly if the patient has developed an abnormal head posture. Conclusion: It is difficult to come to any clear-cut conclusions due to the low numbers of patients that have been studied. It would, however, appear that botulinum toxin and surgery are of some value in the management of acquired nystagmus. Further research is required in this area.