Teaching Video NeuroImage: Centripetal Nystagmus in Blindness

A 58-year-old man with progressive visual loss due to retinitis pigmentosa (Figure, A) was referred to neuro-ophthalmology clinic for abnormal eye movements. Visual acuity was reduced to light perception in both eyes. Eye movement recording showed no nystagmus in primary position. However, each lateral gaze elicited centripetal nystagmus manifested by drift of the eyes to the direction of the previous eccentric gaze and corrective quick phases toward primary position (Video 1). The slow-phase waveforms of nystagmus were mostly characterized by increasing velocity (Figure, B). Brain MRI was unremarkable. Centripetal nystagmus has been reported in patients with cerebellar or brainstem dysfunction and is usually explained by compensatory mechanisms to correct a failure of gaze maintenance (Supplementary Material).1,2 Our case presents centripetal nystagmus associated with visual deprivation. Based on the velocity-increasing waveforms, centripetal nystagmus in blindness may reflect instability in the gaze-holding networks due to a lack of retinal image motion for adaptive recalibration.