Walsh & Hoyt: Rational Basis for Treatment

Ideally, knowledge of the pathogenesis of a form of nystagmus should suggest the treatment. Perhaps the best example for this is the acquired form of PAN, for which an animal model exists, pharmacologic mechanisms have been established, and drug treatment (baclofen) is usually effective. Although such knowledge is still lacking for many forms of nystagmus and saccadic intrusions, headway has been made. In this section, we summarize current concepts of relevant pharmacology and the best therapies for the various disorders. It should be noted that although a number of drugs have been reported to improve nystagmus in individual patients, few have been subjected to controlled clinical trials. When drug treatments fail or effective drugs cannot be tolerated by the patient, certain optical devices may be used to either suppress the nystagmus or negate its visual consequences. Finally, surgery can be performed to either weaken the extraocular muscles or reattach them to the globe in such a way that the resting position of the eyes is at the null position