Voluntary Flutter Presenting During Ophthalmoscopy: A Case Report

This report presents an unusual case of voluntary flutter that presented i n a 20-year-old male with autism spectrum disorder during ocular examination via direct ophthalmoscopy. Refraction and ocular motor balance were normal, and visual acuity was good in each eye (−0.10 logMAR). During direct ophthalmoscopy, a fine intermittent tremor was initiated. The patient was re ferred for further assessment, and eye movements were recorded at 1,000 Hz with an EyeLink 1000 eye tracker. Upon request, the patient could manifest voluntary flutter again and sustain the eye movements with effort during convergence. The voluntary flutter consisted of back-to-back saccadic oscilla tions in a predominantly horizontal direction, with an average frequency of 13 Hz and an amplitude of ∼8°, both reducing over time. We speculate that the discomfort induced by the proximity of the clinician during direct ophthalmoscopy examination may have triggered the eye oscillations. Although the oscillations typically manifest during convergence, atypical forms of voluntary flutter can also occur during divergence. Voluntary flutter can be a useful differential diagnosis in patients with a recently onset apparent “nystagmus,” and no other neurological signs and symptoms.Case Rep Ophthalmol 2022;13:286 –291

Source: Case Reports in Ophthalmology - April 22, 2022 Category: Opthalmology Source Type: research