Latent Nystagmus and Acquired Pendular Nystagmus Masquerading as Spasmus Nutans

SUMMARY: We used ocular motility recordings to identify the characteristics of a rare combination of conjugate, horizontal jerk, and pendular nystagmus in a 9-year-old boy. The clinical diagnoses were amblyopia, left esotropia, congenital nystagmus, and an apparently uniocular pendular nystagmus that mimicked spasmus nutans. Ocular motility recordings revealed an unusual latent/manifest latent nystagmus, pendular nystagmus with characteristics of an acquired nystagmus, and uniocular saccades. The ocular motor data identified clinically unrecognized types of nystagmus and suggested that the pendular nystagmus was acquired in infancy rather than as a result of failure to develop good vision or binocularity. The presence of uniocular saccades adds to the mounting evidence that individual control for each eye exists in humans.