Understanding Nystagmus: Causes, Symptoms, and Physiotherapy Treatment

At PMC Physiotherapy, we understand how unsettling dizziness and vertigo can be— especially when the cause isn’t immediately clear. One of the key signs we look for during assessment is nystagmus, an involuntary eye movement that can provide valuable insight into what’s going on in the inner ear, brain, or visual system. In this blog, our expert Vestibular Rehab Lee Chambers explore what nystagmus is, how it presents, and how it’s assessed and managed in the context of vestibular rehabilitation.

When I am examining a patient with vertigo or dizziness, I spend a lot of time looking at their eyes. What I am looking for is a nystagmus. A nystagmus is an involuntary eye movement that may be there at rest or when performing different head or eye movements. The nystagmus might cause the eyes to move up and down or side to side or in a circular movement. The eyes may drift in one direction and then jerk back in the opposite direction or it can drift back and forth in a steady motion. The way the eyes move will depend on what is causing the nystagmus.

Nystagmus is something that you can be born with. This is called congenital nystagmus. Or it can develop later in life. This is called an acquired nystagmus. This may be as a result of a medical condition affecting your brain, eyes or ears. Or it may just be how your body works and is unrelated to any medical condition. When a patient comes to me for vestibular rehabilitation and they have a nystagmus it is usually as a result of what is causing their vertigo or dizziness and so is an acquired nystagmus.

The sort of symptoms a patient might experience with a nystagmus are dizziness, vertigo, issues with balance, co-ordination, depth perception and vision. The types of symptoms a patient will experience will depend on what is causing it.

Under normal circumstances, when you move your head, a message is sent to your brain from your vestibular system. Your brain uses this message to co-ordinate your eye movement so that the image you see remains in focus. If something is disrupting the ability for their vestibular system, brain and eyes to work together and this can cause nystagmus.

When a patient comes to see me and they have a nystagmus, the first thing I need to do is determine if that nystagmus is as a result of a neurological condition or a problem with their inner ear or vestibular system. This is done with a series of tests looking at a patient’s eye movement and looking at what happens in their eyes when I move their head in certain ways.

Treatment for the nystagmus depends on what is causing it. If during testing, I believe that it is a neurological condition causing the symptoms, I will refer the patient for imaging and a neurological review. If it is because of a vestibular dysfunction, treatment will involve exercises or manoeuvres to address this dysfunction. Once the dysfunction is treated, the nystagmus will also resolve.

If you’re experiencing symptoms such as dizziness, unsteady balance, or unusual eye movements, it’s important to seek expert assessment to determine the underlying cause. At PMC Physiotherapy, our vestibular specialist can carry out comprehensive testing to identify whether your symptoms are related to your inner ear, nervous system, or something else entirely. Book an appointment today to get the answers—and support—you need to feel steady and confident again.