Eye Rolling & Uncontrolled Eye Movement: Symptoms & Causes

What Causes Eye Rolling or Uncontrolled Eye Movement?

Eye rolling or uncontrolled eye movement, or nystagmus, is usually caused by an abnormal function in the part of the inner ear (the labyrinth) or brain that regulates eye movement. The labyrinth helps you sense position and movement.

What Is Nystagmus?

Nystagmus is a condition that results in the eyes making uncontrolled or repetitive movements. It is often accompanied by vision or proprioceptive problems. You may also experience blurry vision and trouble focusing. These movements can happen in one or both eyes, and you may also notice issues with balance. Stress or fatigue can worsen your symptoms.

What causes nystagmus?

The causes of nystagmus can range from minor problems with your inner ear to being a sign of another underlying medical issue. Some common causes include:

• Inner ear issues
• Head injuries
• Drug/alcohol use
• Genetics
• Diseases i.e. multiple sclerosis
• Eye problems, such as strabismus
• Ocular albinism
• Certain medications, such as lithium
• Dehydration

Types of nystagmus

There are two types of nystagmus:

• Congenital nystagmus: Also called infantile nystagmus syndrome, symptoms typically appear in newborns or babies between six weeks and three months after birth. The specific cause is unknown, but physicians suspect there may be a genetic component. Congenital nystagmus usually occurs in both eyes, and blurry vision is a common symptom in older children.

• Acquired nystagmus: Acquired nystagmus is nystagmus that develops any time post-early childhood. It may be a sign of an underlying condition, such as a problem with your middle ear, stroke, head injury, or a medication side effect.

Symptoms of Nystagmus

Other symptoms can include the following:

• Rapid involuntary eye movement
• Eyes rolling back
• Eyes rolling up
• Eyes moving side to side
• Eyes moving in circles
• Eye motion that changes pace
• Nodding the head or holding it in odd positions to help eyes focus
• Symptoms worsening when the head is turned

Diagnosing Uncontrolled Eye Movement

When diagnosing uncontrolled eye movements, I first perform a thorough physical exam, focusing on the inner ear and nervous system, and take down a complete medical history. If I suspect that a patient has nystagmus, I may refer them to an opthamologist or a neurologist, depending on the initial exam and associated symptoms. Additional testing may include:

• Neurological exam
• Ear exam
• Eye exam with specialized equipment called a “slit lamp”
• CT of the brain
• MRI of the brain

One common test to check nystagmus involves spinning a person in circles for approximately 30 seconds, and then stopping and asking them to stare at an object. If nystagmus is present, their eyes will slowly move in one direction before quickly moving the opposite way.

These tests can check to see how the eyes are functioning, and other underlying causes that might be the problem.

Treatment Options

In congenital nystagmus, brinzolamide eye drops may help alleviate symptoms. Always check the expiration dates on medications, and be sure to never use expired eye drops or to share eye drops with others, as this may expose you to infection.

Treatments for acquired nystagmus will differ depending on the underlying condition. In some situations, nystagmus gets better on its own over time, while other times it will go away once the root cause is addressed. Certain medications can ease eye rolling symptoms in adults such as baclofen (Lioresal), a muscle relaxant, and onabotulinumtoxina (Botox).

Though not used routinely, surgery can be done to reposition the eye muscles. It isn’t a cure, but it can help reduce the amount that an individual needs to turn their head to see better.

Acupuncture has also been shown to help improve visual function in nystagmus.

What You Can Do at Home

Wearing specialized contacts or glasses can sometimes improve visual problems due to nystagmus, as can good lighting, reading large-print books (or increasing the print size on your phone or tablet), or using a magnifying device.

Engaging in activities that promote calmness and relaxation, such as meditation, can also help. With both types of nystagmus, the more generally relaxed a person is, the less severe their symptoms.

Related Conditions and Risk Factors

Conditions related to nystagmus include:

• Cataracts: Nystagmus is common in people with cataracts.

• Strabismus: Strabismus is another eye muscle disorder caused by a misalignment of the eyes. It can result in esotropia, an inward turning of the eyes, and hypertropia or hypotropia, which are both types of vertical misalignment.

• Ménière's disease: Ménière's disease is a disorder of the inner ear that causes vertigo, and in severe cases can also be associated with nystagmus.

• Orthostatic hypotension: Orthostatic hypotension is when blood pressure rapidly decreases upon standing up quickly. This is usually due to dehydration, and nystagmus is sometimes present.

• Seizures: Some seizures present with uncontrolled eye movements that can appear to be similar to nystagmus. The eyes may roll upward or sideways in a Petit Mal seizure, and tonic-clonic seizures often involve rhythmic eye movements or the eyes rolling backwards.

Risk factors for nystagmus are:

• If you’ve had a stroke, brain tumor, or head injury

• If you’re taking certain medications i.e. antiseizure medications

• If you have a deficiency of thiamine or B-12

• If you have a nervous system disorder

• If you have a family history of nystagmus

When to See a Doctor

Acquired nystagmus is often caused by an underlying medical condition, so you should see a doctor as soon as possible for further evaluation and to initiate appropriate treatment.

How K Health Can Help

K Health can help you quickly determine whether your eyes rolling backwards or other uncontrollable eye movements necessitate a doctor’s visit. Our doctors are also available to help you learn how to ease your symptoms and what you can do to help prevent them in the future.