Convergent-divergent pendular nystagmus: possible role of the vergence system

We used the magnetic search coil technique to measure horizontal, vertical, and torsional components of convergent-divergent pendular nystagmus in three patients. All showed phase shifts of approximately 180 degrees between the two eyes in the horizontal and torsional planes, but the vertical components were conjugate. Viewing a near target increased the oscillations threefold in one patient and by 60% in a second patient. The waveform was sinusoidal in one patient, but in the other two it was complex, resembling either a sum of several sine waves or a cycloid. When the predominant frequency of the nystagmus was low (1.8 Hz), oscillation of visually mediated vergence might have been responsible; when the frequency was high (6 Hz), the nystagmus might have arisen from an internal instability in connections between nucleus reticularis tegmenti pontis and cerebellar nucleus interpositus, which are important for vergence control.