Shaky Vision

Shaky vision is usually caused due to a condition called nystagmus. The ocular disorder is characterized by rapid, involuntary, and repetitive motion of the eyes. In most cases, such eye movements are from one side to another, but it can also move in a circle or up and down. The movements typically occur in both eyes; it can be fast or slow.

Individuals with shaky vision may be unaware of the unusual movements of their eyes because often the objects do not seem shaking. Patients may turn or tilt their heads to slow down or decrease the eye movements, thereby allowing them to see more clearly.

Types of shaky vision/nystagmus

Shaky vision or nystagmus is of two types:

• INS or Infantile Nystagmus Syndrome, which is congenital: Congenital shaky vision is present from birth, or may develop during infancy when the baby is between 6 weeks to 3 months old. Sensory shaky vision/nystagmus also develops early and is associated with poor eyesight that arises due to varied ocular disorders such as strabismus, cataract, and optic nerve hypoplasia. As children with shaky vision grow older the world will not appear shaky, but the vision will not be as clear as normal. INS is not linked to any other condition; it is generally mild and does not become serious.
• Acquired nystagmus: It occurs at a later stage in life due to an injury or an underlying medical condition. Adult patients suffering from this form of nystagmus may see the world and its varied images as being shaky.

Symptoms

The main symptom of shaky vision is unusual movements of the eyes. Such movements can be vertical, horizontal, or circular in nature, and may be slow or rapid, typically affecting both eyes.

People with shaky vision may also suffer from other signs and symptoms such as:

• Photosensitivity or increased sensitivity to light.
• Vision difficulties.
• Problems of vision in darkness.
• A constant sensation that the world is shaking.
• Keeping the head tilted or in a turned position.
• Patients with large movements of the eyes may suffer from lowered visual acuity, i.e. less than 20/20 sharpness of vision.

Causes

The brain controls the movements of the eyes. The eyes tend to automatically move to adjust and compensate for even a minor movement of the head. This is what causes stabilization of the image that one is seeing and in turn offers a sharper, better image. Individuals with shaky vision suffer from malfunction of those parts of the brain that regulate ocular movements.

INS is present from birth. It is important to check for presence of eye diseases in infants with congenital shaky vision. Acquired shaky vision can be caused due to many different reasons, some of which remain unidentified. It can arise due to ocular diseases, or due to substance abuse, severe medical disorders, etc.

Some of the common causes of shaky vision/nystagmus are listed below:

• People with a family history of shaky vision are at greater risk to inherit the condition.
• Strabismus, cataracts, extreme refractive errors, and other ocular conditions.
• Albinism, a condition marked by deficient skin pigmentation.
• Deficiency of vitamin B12 or thiamine.
• Younger people are most susceptible to developing shaky vision post head injuries arising due to motor accidents, etc.
• Stroke often causes acquired shaky vision in the elderly.
• Brain disorders like tumors or multiple sclerosis that cause abnormalities of brain areas controlling eye movements.
• Use of certain medicines or drugs, especially phenytoin/Dilantin, which is an anti-seizure drug. Intake of sedating medications that cause dysfunction of the labyrinth, lithium, and alcoholism also increase the risk.
• Inner ear diseases like Meniere’s disease or labyrinthitis. Inner ear problems can result in ‘jerk nystagmus,’ wherein the eyes in patients slowly move towards one side and then jerk back in the other direction. This then results in vertigo and nausea. Accumulation of water in one ear can also temporarily give rise to this problem.

Treatment of shaky vision/nystagmus

• Most instances of congenital shaky vision/INS have no permanent cure. Acquired shaky vision is treated after diagnosing the cause and then correcting it. In cases where shaky vision cannot be reversed, doctors will opt for reduction of severity levels via varied treatments.
• Shaky vision arising out of an infection or use of medications usually resolves completely after the cause has been treated. Often, stopping the use of a specific medication, or stopping substance abuse or alcohol intake can also resolve shaky vision.
• Surgery can help alleviate severe cases of shaky vision, but does not fully eliminate it.
• Use of contact lenses or eyeglasses is an important part of shaky vision treatment. Both help improve the vision, but the former is a better alternative.
• Doctors may also prescribe medications to decrease the severity of shaky vision. However, such medicines can result in side effects and hence they are prescribed only when necessary. Botulinum toxin injections, baclofen, and Botox are the common medications given to alleviate shaky vision.
• Biofeedback training can also help find relief.
• Making changes at home to adjust for visual difficulties, dizziness, or disorders for the nervous system is advised.
• Regular eye checkups are recommended.