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    Function of The Gaze System - Purpose of The Gaze Test

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    Changho Lee
    The document discusses the gaze system and gaze nystagmus, describing the purpose and protocol for a gaze test to identify spontaneous eye motion during visual fixation. It details different types of nystagmus that can be observed during gaze testing including direction changing, direction fixed, rotatory, vertical, and periodic alternating nystagmus, each indicating different lesions. Specifics are provided on direction fixed horizontal, vertical, and rotatory nystagmus and hints for distinguishing central from peripheral gaze nystagmus.

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    Function of The Gaze System - Purpose of The Gaze Test

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    Changho Lee
    49 views13 pages
    The document discusses the gaze system and gaze nystagmus, describing the purpose and protocol for a gaze test to identify spontaneous eye motion during visual fixation. It details different types of nystagmus that can be observed during gaze testing including direction changing, direction fixed, rotatory, vertical, and periodic alternating nystagmus, each indicating different lesions. Specifics are provided on direction fixed horizontal, vertical, and rotatory nystagmus and hints for distinguishing central from peripheral gaze nystagmus.

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    nkiGaze

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    The document discusses the gaze system and gaze nystagmus, describing the purpose and protocol for a gaze test to identify spontaneous eye motion during visual fixation. It details different types of nystagmus that can be observed during gaze testing including direction changing, direction fixed, rotatory, vertical, and periodic alternating nystagmus, each indicating different lesions. Specifics are provided on direction fixed horizontal, vertical, and rotatory nystagmus and hints for distinguishing central from peripheral gaze nystagmus.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    49 views13 pages

    Function of The Gaze System - Purpose of The Gaze Test

    Uploaded by

    Changho Lee
    The document discusses the gaze system and gaze nystagmus, describing the purpose and protocol for a gaze test to identify spontaneous eye motion during visual fixation. It details different types of nystagmus that can be observed during gaze testing including direction changing, direction fixed, rotatory, vertical, and periodic alternating nystagmus, each indicating different lesions. Specifics are provided on direction fixed horizontal, vertical, and rotatory nystagmus and hints for distinguishing central from peripheral gaze nystagmus.

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    of 13

    Gaze

    • Function of the Gaze System


    – Maintain visual fixation of an object on the
    fovea of the eye during fixed, visual gaze
    • Purpose of the Gaze Test
    – Identify presence of spontaneous eye motion
    during visual fixation
    Gaze Test
    • Protocol:
    – Gaze Center patient sitting
    • At least 1 meter away
    • Minimum 30 seconds
    – Gaze Center patient sitting
    • Vision denied (and fixation)
    • 8-30 seconds
    – Gaze right, Gaze Left, Gaze Up, Gaze Down all
    with eyes open.
    Gaze Nystagmus
    • Types of nystagmus that can be observed
    during gaze testing
    – 1. Direction changing nystagmus
    • Right gaze – right beating
    • Left gaze – left beating
    • Upward gaze – up beating
    • Points to brainstem or cerebellar lesion
    Gaze Nystagmus
    • 2. Direction Fixed and Horizontal
    – Always in one direction irrespective of direction
    of gaze
    – Indicates peripheral lesion
    • 3. True rotatory gaze nystagmus
    – Indicates brainstem lesion
    • 4. Vertical gaze nystagmus
    – Up-beating: brainstem
    – Down-beating: cervico-medullary
    Gaze Nystagmus
    • 5. Periodic
    Alternating
    – Changes
    direction every
    2-6 minutes
    • Indicates
    cerebellar,
    brainstem or
    midbrain lesion
    • 6. Square wave
    – Rule out
    tense/nervous
    Gaze Nystagmus -- Specifics
    • Direction Fixed Horizontal
    – If the ocular motor battery is normal
    • 96% chance this is due to peripheral vestibular
    system (end organ or nerve) pathology
    • Nystagmus usually beats away from the weak ear
    – Ie. Right beating suggests left ear weakness; left
    beating suggests right ear weakness
    • Nystagmus is stronger with eyes closed
    • ACUTE unilateral peripheral lesions may show a
    rotary component in addition to primarily horizontal
    nystagmus
    – Often can only see with with frenzels or infra-red closed
    cover
    Gaze Nystagmus -- Specifics
    • Direction- Changing Horizontal
    – Need to rule out:
    • End point nystagmus
    • CNS medications
    • Horizontal canal BPPV
    Gaze Nystagmus -- Specifics
    • Vertical
    Nystagmus
    – Upbeating:
    • Brainstem or
    cerebellum
    • NEVER Peripheral
    • With eyes closed
    only: unknown
    clinical
    significance
    – Down beating: Arnold-Chiari Malformation
    • Lesion in
    cerebellum or www.members.shaw.ca/hilaryking/Chiari.JPG

    cervico-medullary
    Downbeat Nystagmus
    Gaze Nystagmus -- Specifics
    • Rotary
    – Brainstem (vestibular nuclei)
    – Seen in cerebellar disease also
    – AS SEEN IN GAZE NOT BPPV
    • Ocular Nystagmus
    – Pendular with center gaze
    – Never vertical
    – Suppresses with convergence
    – Has null point
    – Present from early life
    – Site of lesion--- unknown
    Gaze Nystagmus - Hints
    • Central vs. Peripheral
    – 1. Less likely central if noted in primary
    position
    – 2. Central origin gaze nystagmus will be equal
    or greater with fixation compared to non-
    fixation for Slow-component velocity
    • Peripheral, slow-component velocity is significantly
    reduced with fixation
    – 3. Presence of rebound nystagmus (transient
    nystagmus where the fast component is in the
    direction of the last eye movement) following
    return to primary position from lateral gaze
    position where nystagmus present
    • Much more likely to be brainstem or cerebellar
    Analysis - Gaze
    Analysis - Gaze
    • Percent Ends:
    – A “%” of the
    current test “step”
    is discarded from
    beginning and
    end.
    • Increase the % and
    the green cursors
    move together with
    less data analyzed.
    • Prime Threshold:
    try not to adjust
    – This gets rid of
    small “flutter” in
    the eye signal
    – If you adjust it too

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