Oscillopsia

• oscillopsia is a symptom of jumbling eye movements, manifested as blurred vision when walking or running, and is caused by poor stabilization of the retinal image during head movement
  • occurs primarily from loss of the vestibular ocular reflex (VOR) or ocular oscillations (1,2,3)
    • the former is a conjugate eye movement that stabilizes the vision in the opposite direction of head motion
  • in contrast, ocular oscillation or nystagmus caused by certain brain abnormalities (e.g., cancer metastasis or radiation necrosis), may also provoke oscillopsia (4)
    • radiation-induced oscillopsia in nasopharyngeal carcinoma patients is attributed to bilateral VOR loss, possibly as a result of higher radiation doses (5)

With respect to oscillopsia in multiple sclerosis (6):

• consider gabapentin as a first-line drug to treat oscillopsia
• consider memantine as the second-line treatment for oscillopsia in people with MS
• refer the person with MS for specialist advice if there is no improvement of oscillopsia after treatment with gabapentin and memantine or side effects prevent continued use

Reference:

• 1. Bender MB. Oscillopsia. Arch Neurol 1965; 13: 204-213
• 2. Chambers BR et al. Bilateral vestibular loss, oscillopsia, and the cervico-ocular reflex. Otolaryngol Head Neck Surg 1985 ;93 : 403-407
• 3. Sargent EW et al .Idiopathic bilateral vestibular loss. Otolaryngol Head Neck Surg 1967;116: 157-162.
• 4. Lee AWN et al. Clinical diagnosis of late temporal lobe necrosis following radiation therapy for nasopharyngeal carcinoma. Cancer 1988; 61:1535-1542.
• 5. Chen PR et al. Radiation-induced oscillopsia in nasopharyngeal carcinoma patients. Int J Radiat Oncol Biol Phys. 2005 Feb 1;61(2):466-70
• 6. NICE (November 2019). Multiple sclerosis management of multiple sclerosis in primary and secondary care.