Occular Oddity


  • Specializes in 3 years MS/Tele, 2 years Neuro ICU/CCU. Has 5 years experience.

I just recently had a GI bleeding patient come in, but he was admitted to us because his ammonia level was sky-high and he was showing neuro symptoms. Totally unresponsive to stimulus, but a bit of an oddity in his assessment. At least to me. In 2 years I hadn't seen this, and none of the other nurses on the unit had either.

Pupils were equal, VERY sluggish and he wasn't tracking anything, but his eyes were roaming. Didn't matter if his eyelids were held open or allowed to close. Didn't matter if his head was midline, turned left or turned right. His eyes were traveling back and forth. Slow, steady, all the way left, all the way right and then back to the left. It was like watching a metronome.

I've always seen nystagmus as jerky/twitchy, this was slow and steady and involved both eyes equally and in synch. Maybe a form of seizure activity? He came in at the end of my shift, so while I reported my findings to the neurologist I didn't have the opportunity to really talk to him. Does anyone know what this would be considered? I charted it as a nurses note b/c I had no idea what it should be called. Have you seen this, and if so, what was it?

Thanks in advance.

JustBeachyNurse, RN

1 Article; 13,952 Posts

Specializes in Complex pediatrics turned LTC/subacute geriatrics. Has 13 years experience.

I believe it's still considered a form of neurological nystagmus related to high ammonia. Let me see is I can find a reference.

I've seen slow horizontal nystagmus in hepatic encephalopathy with high ammonia levels.

Medscape: Medscape Access


52 Posts

Specializes in 3 years MS/Tele, 2 years Neuro ICU/CCU. Has 5 years experience.

Thank you! None of us nurses were sure what to call it.