Vertical optokinetic stimulation induces diagonal eye movements in patients with idiopathic infantile nystagmus

John R. Economides, Young Woo Suh, Joshua B. Simmons, Daniel L. Adams, Jonathan C. Horton

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    1 Citation (Scopus)


    PURPOSE. In patients with early ocular misalignment and nystagmus, vertical optokinetic stimulation reportedly increases the horizontal component of the nystagmus present during fixation, resulting in diagonal eye movements. We tested patients with infantile nystagmus syndrome but normal ocular alignment to determine if this crosstalk depends on strabismus. METHODS. Eye movements were recorded in seven patients with infantile nystagmus. All but one patient had normal ocular alignment with high-grade stereopsis. Nystagmus during interleaved trials of right, left, up, and down optokinetic stimulation was compared with waveforms recorded during fixation. Six patients with strabismus but no nystagmus were also tested. RESULTS. In infantile nystagmus syndrome, horizontal motion evoked a mostly jerk nystagmus with virtually no vertical component. A vertical optokinetic pattern produced nystagmus with a diagonal trajectory. It was not simply a combination of a vertical component from optokinetic stimulation and a horizontal component from the subject’s congenital nystagmus, rather in six of seven patients, the slow-phase velocity of the horizontal component during vertical optokinetic stimulation differed from that recorded during fixation. In the six strabismus patients without nystagmus, responses to vertical optokinetic stimulation were normal. CONCLUSIONS. In patients with congenital motor nystagmus, a vertical noise pattern drives a diagonal nystagmus. This appears to arise because of crosstalk between the vertical and horizontal components of the optokinetic system. This abnormal response to vertical stimulation is not caused by strabismus because it occurs in patients with infantile nystagmus without strabismus. Moreover, it is absent in patients with strabismus and no spontaneous nystagmus.

    Original languageEnglish
    Article number14
    JournalInvestigative Ophthalmology and Visual Science
    Issue number6
    Publication statusPublished - 2020 Jun


    • Accommodative esotropia
    • Congenital motor nystagmus
    • Crosstalk
    • Exotropia
    • Fusional maldevelopment
    • Optokinetic nystagmus
    • Reversed optokinetic nystagmus
    • Slow-phase velocity
    • Strabismus

    ASJC Scopus subject areas

    • Ophthalmology
    • Sensory Systems
    • Cellular and Molecular Neuroscience


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