Nystagmus and Dizziness
Nystagmus is an eye movement that you cannot control. Your eyes may move:
- From side to side
- Up and down
- In a twisting or rolling motion
The movement may be slow, fast, or a mix of both. Nystagmus is different from an eyelid twitch. With nystagmus, the eyes move—not just the eyelid.
How Does Nystagmus Relate to Dizziness and Vertigo?
Your inner ears work like motion sensors. They tell your brain when your head is moving. Your brain then moves your eyes to help keep your vision steady. Think of your eyes like a camera. Your inner ears and brain act like the camera’s stabilizer. They help keep the picture clear while you move. If the inner ears and brain send mixed signals, your eyes may move even when your head is still. This can make your brain think that you or the room is moving.
Because of this, you may feel:
- Dizziness
- Spinning, called vertigo
- Unsteadiness
- Nausea
- Blurry vision
- A feeling that the room is jumping or bouncing
Not everyone with nystagmus feels dizzy. Some people are born with nystagmus or develop it during the first few months of life. This is often called infantile nystagmus. It can happen when the parts of the eyes and brain that control vision and eye movement develop differently.
Sometimes it occurs on its own, and other times it is linked to a vision condition, such as albinism or a problem with the retina or optic nerve. Because the brain grows up with the eye movement, it often learns to adjust. For this reason, many people with lifelong nystagmus do not feel dizzy or feel like the world is moving.
Why Is My Provider Checking for Nystagmus?
The way your eyes move can give your provider important clues as to the cause of your symptoms.
Your provider may look at:
- The direction of the eye movement
- How fast the eyes move
- How long the movement lasts
- Whether it happens in room light or darkness
- Whether it starts after a head or body movement
- Whether looking in a certain direction changes it
These clues may help show whether the problem is coming from the inner ear, the brain, the eyes, a medicine, or another health condition.
Nystagmus is a clue. It does not always give a diagnosis by itself.
What Can Cause Nystagmus?
- Inner ear or balance disorders, such as BPPV, vestibular neuritis, or Ménière’s disease.
- Conditions affecting the brain or nervous system, such as stroke, multiple sclerosis, or problems involving the cerebellum.
- Vision or eye conditions, especially when nystagmus begins in infancy or early childhood.
- Genetic or developmental differences that affect how the eyes and brain control eye movement.
- Head injury or concussion.
- Certain medicines, drugs, or alcohol.
- Normal responses to certain movements or visual situations. Some types of nystagmus can occur normally, such as when watching objects move quickly past you.
- Sometimes the exact cause is not known, particularly with some forms of infantile nystagmus.
Will Checking for Nystagmus Help?
Assessing for nystagmus may help your provider better understand your dizziness. The results may help guide more testing or treatment.
Treatment depends on the cause. It may include:
- A repositioning maneuver for BPPV
- Vestibular rehabilitation
- Treatment for migraine or an inner ear condition
- A change in medicine
- Care for an eye or brain condition
Nystagmus itself does not always need treatment. The main goal is to find out what is causing the eye movement and treat the underlying problem when possible.
Before Your Appointment
Your provider may ask you to:
- Bring a list of your symptoms and when they started
- Write down what triggers your dizziness
- Bring a list of your medicines
- Avoid alcohol before testing
- Avoid certain medicines before vestibular testing
Do not stop taking any medicine unless your provider tells you to. Tell your provider if you have neck or back problems, recent surgery, severe motion sickness, or trouble lying flat.
What Should I Wear and Bring?
Wear comfortable clothing and safe, flat shoes.
Bring:
- A photo ID
- Your insurance card
- A list of your medicines
- Glasses or hearing aids, if you use them
- Notes about your dizziness and other symptoms
Avoid heavy eye makeup if video goggles will be used. Makeup may make it harder for the cameras to record your eyes.
Should I Bring a Ride?
Many people can drive themselves after a basic eye movement exam.
You may want to bring a driver if:
- You have strong dizziness or vertigo
- You have trouble walking safely
- Testing often makes you sick
- Your appointment includes a full vestibular test
- Your provider tells you not to drive
Do not drive if you feel too dizzy, sleepy, or unsteady to drive safely.
During Your Appointment
Your provider will watch how your eyes move.
You may be asked to:
- Look straight ahead
- Look to the right, left, up, or down
- Follow a moving light or target
- Move or shake your head
- Sit, lie back, or roll onto your side
- Wear video goggles that record your eyes
Some testing is done in room light. Other testing may be done in darkness with special goggles. Darkness makes it easier to see eye movements that your brain may hide when you can focus on an object.
Your provider may also complete a VNG or another balance test.
How Might I Feel?
You may feel:
- Dizzy
- Spinning
- Unsteady
- Nauseated
- Tired
- Eye strain
- Like your vision is moving or bouncing
These symptoms are often brief. Tell your provider if you need a break.
When Will I See Results?
Your provider may explain some findings during the visit. A full report may take longer if eye movements were recorded or several tests were completed. The results must be reviewed along with your symptoms, health history, hearing, balance, and other test results.
What Should I Do After?
- Sit until you feel steady
- Move slowly when standing
- Drink water if allowed
- Eat a light meal if you feel nauseated
- Avoid driving until you feel safe
- Follow your provider’s instructions
Continue any exercises or treatments that your provider has approved.
When Should I Call My Provider?
Call your provider if:
- Your vision looks like it is jumping or bouncing
- Your dizziness is becoming more severe
- You have new falls or trouble walking
- You have repeated vomiting
- Your symptoms do not settle after testing
When Should I Get Urgent Medical Help?
Get emergency medical help for sudden dizziness or nystagmus with:
- Weakness or numbness on one side
- Trouble speaking or understanding words
- New double vision or loss of vision
- A sudden, severe headache
- Fainting
- New confusion
- Severe trouble standing or walking
A sudden change in hearing also needs urgent medical care.
Key Points to Remember
- Nystagmus is an eye movement you cannot control.
- It is different from an eyelid twitch.
- Nystagmus may happen when the inner ears and brain send mixed movement signals.
- It can occur with dizziness, vertigo, nausea, or balance problems.
- Not everyone with nystagmus feels dizzy.
- The pattern of eye movement can help your provider find the cause.
- Nystagmus is a clue, not a diagnosis by itself.
- Testing is generally safe but may briefly trigger dizziness.
- New nystagmus in an adult should be checked by a healthcare provider.
Additional Resources
- American Academy of Ophthalmology – What Is Nystagmus?
- Cleveland Clinic – Nystagmus: Definition, Causes, Testing & Treatment
- Johns Hopkins Medicine – Nystagmus