How do you manage a child presenting with apparently isolated nystagmus?

Nystagmus is a type of eye movement which can be physiological (normal), or associated with myriad eye disorders and neurological conditions. As such, it is commonly encountered in paediatric practice and context is key. Accordingly, children who present with apparently isolated nystagmus can cause significant clinical concern due to the bewildering number of underlying aetiologies in an otherwise broadly well child. This is compounded by the complexity of eye movement disorder definitions, descriptions, features and classification systems. Clinical workup and subsequent management of these children can be extremely variable and depend on how, and to whom the child has presented, availability of investigations and cultural familiarity with single specific causes. In this article we take the non-specialist clinician through a methodical approach to managing children with apparently isolated nystagmus in an Q and A format. We provide some key clinical practice points and discuss subsequent management.