Surgeries are performed for congenital nystagmus in the following five circumstances:

1. Surgery for LMLN

Latent Manifest Latent Nystagmus is typically associated with strabismus. It can also be associated with reduced vision and rarely with wobble in the environment. Perfect ocular alignment fixes this. This can be achieved with glasses and/or surgery. In general the success rates for the surgery are around 80%.

2. Torticollis in Congenital Nystagmus

Torticollis means an abnormal head position, and this is used by some patients with congenital nystagmus to improve vision - these patients position their head at the zone of least nystagmus (best vision). Eye muscle surgeries to substantially improve the abnormal head posture are successful 80-90% of the time. These sometimes result in small improvements in vision. About 10% of patients need a second surgery.

3. Artificial Divergence Surgery in Congenital Nystagmus

Some patients with congenital nystagmus have improved vision when they converge their eyes to look at something close up. With prismatic spectacles we can sometimes produce the same result when they look in the distance. There is an operation which can simulate the effect of these glasses. The success rate is 80+%. The need for a second surgery is around 10%.

4. Surgery in Periodic Alternating Nystagmus

Periodic alternating nystagmus is one of the types of congenital nystagmus. It is more common in patients with albinism. Large weakening surgeries on all the horizontal muscles substantially lessens the tendency to head turns and improves vision in more than half the patients. About 10% of patients need a second surgery for induced ocular misalignment.

5. "New" Operation

For patients with congenital nystagmus for whom none of the above interventions are relevant, Dr. Hertle has demonstrated in a small number of patients that "tenotomy only" surgery improves vision in about half the patients. Of all the surgeries described this is the simplest surgery (probably also means the safest surgery). There is not enough experience with this procedure to know how many (if any) patients would require a second surgery.

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