Nystagmus may be asymptomatic or cause oscillopsia and visual blur. Sophisticated electrophysiologic eye-movement recordings have helped separate the different types of nystagmus, which total at least 45 in all. Without the aid of recordings, the physician can observe only the general characteristics of the nystagmus pattern. Careful observation and documentation of the eye movements not only help categorize the movement but facilitate future examinations. In describing the nystagmus, the physician should note the movement's speed (slow to fast), amplitude (fine to coarse), and direction in each of the nine gaze positions. Maneuvers that accentuate the nystagmus should be documented also. An example is use of down-going optokinetic targets to bring out convergence-retraction nystagmus. Some gaze positions or maneuvers can bring out symptoms of vertigo or oscillopsia, and this should be recorded in the chart also. Sometimes, the nystagmus is seen better by using the slit lamp or ophthalmoscope.
Only a few types of nystagmus are specific enough in pattern to be diagnostic. Usually, the physician has to rely on a combination of the history and physical findings to interpret the diagnostic importance of nystagmus. If an eye-movement recording laboratory is available, more accurate categorization of the abnormal eye movement can be helpful in the patient's evaluation.