PURPOSE: Spasmus nutans is a condition that includes asymmetric nystagmus and occurs during the amblyogenic period. Because specific alterations in early visual experience are known to be associated with changes in visual development, relations between spasmus nutans and abnormal visual sequelae were examined. METHODS: The records of 18 patients with spasmus nutans were reviewed retrospectively. The incidence of strabismus, amblyopia, anisometropia, and astigmatism was compared with published age-matched control subjects. RESULTS: There was a significantly higher incidence of strabismus (10 of 18) and amblyopia (8 of 18) of the eye with the greater amplitude of nystagmus. No correlation of refractive error with lateralization of nystagmus could be established. Twelve of 18 patients required spectacles for improvement in visual acuity and for treatment of amblyopia. Best-corrected visual acuity averaged 1.20 Snellen lines poorer than age-adjusted normative values; however, loss of visual acuity was, in most cases, symmetric and not related to lateralization of nystagmus. CONCLUSION: Early detection and treatment of anticipated abnormal visual issues in patients with spasmus nutans will optimize visual outcomes.