Downbeat nystagmus is a common type of central vestibular nystagmus that often produces oscillopsia or blurred vision. It is a vertical jerk-waveform nystagmus with upward slow phases and downward quick phases. In this chapter, we begin by reviewing the clinical features of downbeat nystagmus. We next list the common causes for downbeat nystagmus, which include inherited cerebellar degenerations, acquired cerebellar degenerations, congenital hindbrain anomalies, stroke, tumors, and medications. We then discuss the workup and management of paraneoplastic cerebellar degeneration, which is most commonly associated with cancers of the lung, ovary, and breast. Lastly, we review medical treatment options for downbeat nystagmus.