Timothy C. Hain, MD. • Page last modified:
August 2, 2020
About 8% of the normal population can voluntarily produce ocular flutter, usually during convergence (Zahn, 1978). This can be spotted because the pupil constricts during the convergence effort. This is usually considered a "party trick", and not a disease at all. Only a few papers have been written with "voluntary nystagmus" in their title (46 as of 2015)
This is usually a brief high frequency horizontal shimmer, that cannot be sustained for more than about 5 seconds. Occasional persons also appear to be able to produce voluntary multidirectional eye movements resembling opsoclonus.
While there are a few other types of nystagmus under voluntary control, such as some variants of congenital nystagmus, for the most part, the term voluntary nystagmus is reserved for this group.
Why do people produce voluntary nystagmus ?
- Some patients who are dizzy use voluntary nystagmus to suppress their sensation of dizziness. This can cause a confusing picture of ocular flutter with an underlying nystagmus. It most commonly is found in persons with bppv.
- There are also patients who have a tendency towards flutter in whom the high frequency saccades of vertigo or convergence are triggers.
- Some patients have spasms of convergence, on which is superimposed nystagmus (this might not be voluntary).
- Some people use their parlor trick of voluntary nystagmus to feign disease to obtain disabilty or access to addictive medication. (Razumovskii et al, 1989)
Supplemental material : Video of voluntary nystagmus.
Supplemental material : Another video of voluntary nystagmus. (Courtesy of Dr. Dario Yacovino).
Note how the pupil constricts during the rapid horizontal shimmering.
The main approach to treatment of voluntary nystagmus is plus lenses to reduce the need for accomodation. (Neppert and Rambold, 2006).
References regarding voluntary nystagmus:
- Neppert, B. and H. Rambold (2006). "Familial voluntary nystagmus." Strabismus 14(2): 115-119.
- Razumovskii, M. I., et al. (1989). "[A case of voluntary nystagmus during medical evaluation of work capacity]." Vestn Oftalmol 105(4): 76-77.
- Sato, M., et al. (1999). "Voluntary nystagmus associated with accommodation spasms." Jpn J Ophthalmol 43(1): 1-4.
- Zahn, J. R. (1978). "Incidence and characteristics of voluntary nystagmus." J Neurol Neurosurg Psychiatry 41(7): 617-623.
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August 2, 2020