Pupilla learning lab
Nystagmus Simulator
Explore the nystagmus conditions in Pupilla’s eye exam simulator. Observe waveform, direction and gaze dependence, then connect your observations to the learning guide.
- Free in your browser
- English & Arabic
- Education & training
This workflow uses the shared Eye Exam Simulator. The button opens the existing examination tools.
Your first practice session
- Open the condition selector and choose a nystagmus example.
- Observe primary position before changing gaze.
- Describe the movement, then compare another example.
Common mistakes to avoid
- Naming every oscillation from direction alone.
- Assuming a simulated pattern establishes a patient’s diagnosis.
For education and training only. Pupilla is not a medical device and must not be used for diagnosis or treatment decisions.
Understand the principles
Types of nystagmus: gaze-evoked, downbeat, upbeat, see-saw and pendular
Nystagmus is a rhythmic, involuntary to-and-fro movement of the eyes. In jerk nystagmus a slow drift is followed by a fast corrective flick, and the nystagmus is named by the direction of the fast phase; in pendular nystagmus both phases have the same speed. Downbeat nystagmus usually points to the craniocervical junction or cerebellum, upbeat nystagmus to the brainstem or cerebellum, see-saw nystagmus to the parasellar region, and gaze-evoked nystagmus to cerebellar dysfunction or drugs such as alcohol and anticonvulsants.
Internuclear ophthalmoplegia (INO), one-and-a-half syndrome and gaze palsies
Internuclear ophthalmoplegia (INO) is caused by a lesion of the medial longitudinal fasciculus (MLF). On side gaze, the eye on the side of the lesion fails to adduct or adducts slowly, while the other eye abducts with nystagmus; convergence is often preserved. A lesion of the abducens nucleus or the paramedian pontine reticular formation (PPRF) causes a horizontal gaze palsy toward that side, and when it also involves the neighboring MLF the result is one-and-a-half syndrome: the only horizontal movement left is abduction of the opposite eye.
Questions about this simulator
What can I practise with the Nystagmus Simulator?
Explore the nystagmus conditions in Pupilla’s eye exam simulator. Observe waveform, direction and gaze dependence, then connect your observations to the learning guide.
Do I need to install software or create an account?
Open the simulator free in a modern browser without installation. An account enables supported saved progress and results; coverage varies by module.
Can I use a phone or tablet?
You can access it in modern phone and tablet browsers. A larger screen gives diagrams and controls more space; performance depends on the device and browser.
Does this replace clinical training or patient diagnosis?
For education and training only. Pupilla is not a medical device and must not be used for diagnosis or treatment decisions.
References & further learning
Sources for the teaching principles. Listing a source does not imply its institution endorses or validates this simulator.