Congential Nystagmus: what I need to know. Augmented Sinskey Extirpation Procedure for Nystagmus

Treatment for Congenital Nystagmus

Patients with Congential Nystagmus can have a significant decrease in vision because their eye moves so much to limit the ability to see a stationary target. When we check vision, for instance, we know that covering one eye to be able to check the vision of an eye, will cause both eyes to move more than usual. Thus we often have to cover one eye with a high power lens to get a true sense of the other eye’s vision.

This procedure below helps patients with Congenial Nystagmus by limiting the eye’s ability to move which helps patients vision long term. 

Dr. Sinskey, the doctor who developed this procedure, recently died, so our prayers are with his family in thanksgiving for this excellent option for our patients.

Augmented Sinskey Extirpation Procedure for Nystagmus.

The procedure is designed to give a quiet position when looking straight ahead for optimal vision and
The surgery will quiet the nystagmus when the head is looking straight ahead but will be seen when the
eyes are turned to the right and left side. They can still move their eyes to the side, they just still shake
when looking right and left, like before the surgery. Patients will turn their head when looking side to
side to use their new quiet position, or null point.
Vision has improved in every patient I have operated but one, but I cannot predict ahead of the surgery
how much better each patient will see. Distance vision in straight ahead viewing, has improved from 1
to 5 lines on the Snellen Acuity chart, and near vision has improved 2 to 8 lines, even in children with
other ocular anomalies (cataract, coloboma, and albinism).

Prevailing procedures for nystagmus often have sub-optimal results, and therefore, new concepts even
if published, receive little attention.  Dr. Robert Sinskey, in 2002, proposed that control could
only be obtained by removing the front portion of the muscle so no further direct attachment could
allow the nystagmus to persist. 

In the initial Sinskey report in 2002, of 4 patients, all experienced marked improvement in the
nystagmus but 2 developed strabismus (eye misalignment) and one developed a hematoma (large blood

The risks have decreased for this procedure. Still though there are risks. Risks:
The surgery is done on the eye muscles outside the eye and no surgery is done inside the eye. None the
less we cannot guarantee that something unexpected could occur to reduce vision or cause a complete
loss of vision. This loss has not yet occurred.
The primary risk is postoperative strabismus (eyes are mis-aligned) that could require secondary
surgery for repair which can occur in about 20% of patients. 

The following codes are provided for you to ask your insurer if the procedure is covered, in which case
you would be responsible only for any uncovered fees and insurance deductibles. 

Nystagmus ICD-9 Diagnosis code 379.50
Procedure Codes: CPT codes- 

For the nystagmus procedure…………………………..67312 R&L 

If reoperation is required for strabismus, then either 67318 or 67314 or 67316-67320 may be required

The above was adapted from an excellent posting by Dr. Lingua: 

Robert W. Lingua, MD
Please visit the web site:
Susan Bohannan 

Phone 949-824-4122 Fax 949-824-4015 
Gavin Herbert Eye Institute, 
Department of Ophthalmology
University of California, Irvine, 

850 Health Sciences Road, Irvine, Ca 92697-4375

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