The evidence on tenotomy of horizontal eye muscles for nystagmus (with reattachment at their original insertions) raises no major safety concerns, but current evidence on its efficacy is inadequate in quantity. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research.
Clinicians wishing to undertake tenotomy of horizontal eye muscles for nystagmus (with reattachment at their original insertions) should take the following actions.
Inform the clinical governance leads in their Trusts.
Ensure that patients and their carers understand the uncertainty about the procedure's safety and efficacy and provide them with clear written information. In addition, the use of NICE's information for the public is recommended.
Audit and review clinical outcomes of all patients having tenotomy of horizontal eye muscles for nystagmus (with reattachment at their original insertions; see section 3.1).
Patient selection and follow-up should take place in specialist units with experience in the management of ocular motility disorders.
NICE encourages further collaborative data collection, including information on visual acuity and quality of life, and may review the procedure on publication of further evidence.