September 2022

OPHTHALMOLOGY

A CASE OF DOWNBEAT NYSTAGMUS AND OSCILLOPSIA

A 73-year-old woman presented to Northwestern Medicine Ophthalmology with a years-long history of intractable oscillopsia and blurred vision secondary to downbeat nystagmus which did not respond to medical treatment. She presented for surgical consultation because of significant orthopaedic neck issues from a compensatory posture with her chin down. This head position reduced her symptoms by moving her eyes into upgaze where she had an effective null point with reduced oscillopsia. When her eyes were in upgaze, her visual acuity improved to 20/50 from 20/200 in each eye with prominent downbeat nystagmus in the primary position.
 
To move the upgaze null position associated with improved visual acuity into the primary position, we performed bilateral superior rectus recessions on adjustable sutures and bilateral inferior oblique myectomies. The surgery was successful in improving visual acuity to 20/40 and reducing the nystagmus (with minimal limitation of upgaze) and oscillopsia. While this degree of disability from both visual dysfunction and orthopaedic neck issues is unusual from nystagmus, this surgical intervention can be considered to improve vision and reduce long-term neck injuries.  

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