Q. Why do my pupils constrict when I get nystagmus, despite being in total darkness?

Answered by
Dr. Ashok Kumar Choudhary
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Aug 11, 2017

Hi doctor,

I am a 21 year old female. I suffer from very rapid up-beating and sometimes down-beating nystagmus, which exclusively occurs in the absence of visual stimulation. That is with my eyes closed and Frenzel goggles on. When the nystagmus occurs quite intensely, my eyes will bounce under my eyelids and cause quite a nuisance. My neuro-otologist provided me with goggles to record my own eyes. From the recordings, I notice my pupil constrict significantly when they nystagmus occurs intensely despite being in total darkness. Why do my pupils constrict when the nystagmus occurs despite being in total darkness? When the nystagmus stops, my pupils dilate back to the normal size.

I was diagnosed with a vestibular migraine. My symptom includes vertigo, dizziness, headaches, balance issues, binaural tinnitus, and cognitive issues. I have undergone routine vestibular testing. My rotational chair and caloric test results came back hyper-responsive. VEMP testing came back normal. And my brain MRI came back unremarkable. I have been on Amitriptyline 25 mg, and I am currently on Pizotifen 0.5 mg.



Welcome to icliniq.com.

I read your query and understand your concerns.

  • I would like to inform you that in vestibular migraines, there is overstimulation of sympathetic system, which is responsible for contraction of the pupil despite being in total darkness.
  • In other words, it is a sign of same illness, and there is nothing abnormal about it other than the illness which causes it. For clarity, nystagmus and constriction of pupil have the same pathology.

I hope this answers you. If you have more questions feel free to write back to me. Thanks and regards.

For more information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist

Hi doctor,

Thank you so much for your response. It was really helpful. As a final to this, does constriction of the pupil occur in patients who have nystagmus that is not caused by vestibular migraines? Or is constriction of the pupil something that only occurs for patients who have nystagmus caused by vestibular migraines? And I have also noticed that my nystagmus does not necessarily get worse when I am experiencing heightened vertigo and dizziness. At times when I have had the worst nystagmus, I did not necessarily feel excessively dizzy or vertigo. Is that a reason for this? Thanks.



Welcome back to icliniq.com.

Thanks for the follow-up.

  • There is no rule to say that only vestibular migraine individuals get contraction of the pupil during nystagmus. There are other conditions such as brain stem stroke, Horner's syndrome, and Wallenberg syndrome, which could have nystagmus as well as pupillary contraction at the same time.
  • The vertical nystagmus associated with posterior fossa structures of our cranial cavity (as in your case) is often associated with dysfunction of the sympathetic nervous system, which causes contraction of the pupil as explained above.
  • I do not think there is a connection between the severity of dizziness and vertigo with nystagmus in causing pupillary contraction. They can occur independently of each other.

I hope this answers you further. Feel free to contact me when you have any questions related to my specialization or anything that bothers you. Thanks and regards. Wish you great health ahead.

For further queries consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist

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