Pharmacological management of nystagmus: An in-depth review for clinical practice

Nystagmus, characterized by involuntary ocular movements, presents significant challenges in both congenital and acquired forms, often significantly impacting visual acuity and quality of life. This comprehensive review examines the current landscape of pharmacological interventions for nystagmus, highlighting several key drug classes and their mechanisms of action. To identify relevant studies, an extensive literature search was conducted in PubMed, Web of Science, and Scopus, covering English-language articles from 1960 to 2025. Gabapentin, a calcium channel blocker with potential effects on gamma-aminobutyric acid (GABA) activity, and baclofen, a GABAergic agent, have shown promise in treating both congenital and acquired forms, whereas glutamate antagonists like memantine have demonstrated efficacy in some cases. Potassium channel blockers, including aminopyridines, have proven especially effective for certain acquired nystagmus types, particularly downbeat nystagmus. The potential of anticholinergic drugs and benzodiazepines in specific nystagmus subtypes is also discussed. Efficacy often varies among individuals, highlighting the need for personalized approaches. This review underscores the importance of both nystagmus reduction and preservation of normal eye movements. Although many medications show promise, most studies have small sample sizes and lack long-term data, making direct comparisons challenging. Therefore, further research (particularly large-scale randomized controlled trials) is needed to support the development of novel targeted therapies, including combination treatments or adjunctive nonpharmacological approaches, to improve management of this complex condition.