Observe the eye for any abnormal head posture which may be used to dampen
nystagmus (to achieve null point) especially in those with congenital nystagmus.
Look for any nystagmus in the primary position. Observe for:
its plane: horizontal, vertical, rotatory or see-saw
its type: jerk (phases of unequal velocity) or
pendular (phases with equal velocity)
its direction: direction of the fast phase in jerky
its amplitude: fine, medium or coarse
Perform the ocular motility by getting the patient to fixate on an object
(such as your finger or a picture) placed about 1/2 metres away. Move the
object from right to left, upwards and downwards. Place the object at least
5 seconds at each direction to elicit the nystagmus. Observe if the amplitude
of the nystagmus is increased or decreased in each direction.
Tip 1: Avoid extreme of gaze in each direction
as this may elicit physiological nystagmus
Tip 2: In jerky nystagmus, the amplitude is increased
when the eyes turn in the direction of the quick phase.
Ask the patient to fixate on a distant object (such as a Snellen's chart)
and then on an accommodative target (such as a picture). Observe for any
dampening of amplitude (null point) with convergence when the eyes accommodate.
Perform cover test on each eye in turn to elicit manifest latent nystagmus.
You may be asked to perform further examination based on your findings.
Tip 1: In the presence of jerky nystagmus or internuclear
ophthalmoplegia, look for cerebellar signs such as pass-pointing or disdiadochokinesia
Back to the OSCE clinical methods
Tip 2 In pendular nystagmus, look for conditions
such as ocular albinism, congenital cataract or optic nerve hypoplasia.
Tip 3: In see-saw nystagmus, test for bitemporal