Medical treatments for abnormal eye movements: Pharmacological, optical and immunological strategies

Purpose: To review current medical treatments for nystagmus and saccadic intru Methods: Evaluation of studies that have used reliable measurement of eye movements and visual acuity before and after treatment. Interpretation of results in light oi physiological and pharmacological studies in animals, and recent immunological advances. Results: There are many case reports of patients with abnormal eye movements being improved by a variety of drugs, but few double-blind, controlled studies have been carried out. Most promising are agents that mediate their effects through the neurotransmitter gamma-aminobutyric acid: such drugs include baclofen and gabapentin. Botulinum toxin, injected into selected extraocular muscles or the retrobulbar space, can abolish nystagmus for several months, but often produces troublesome side-effects, such as diplopia and ptosis, which limit its value. Optical measures to either reduce nystagmus by manipulating vergence angle, or reduce retinal image motion, help some patients. Opsoclonus occurring in association with cancer may be successfully treated with an immune-adsorption technique using a protein A column. Conclusions: There is need for controlled, blinded studies to evaluate the many agents reported to improve visual symptoms in individual patients with abnormal eye movements.