Halpern's syndrome

Timothy C. Hain, MD, • Most recent update: March 7, 2021

This is a very obscure condition, originally described by Halpern in 1964. Halpern described induction of disturbed balance and vision, associated with inner ear disturbances, which was alleviated by looking with the other eye (Halpern 1964). This syndrome was thought by Halpern to be due to a permanent disturbance of integration of visual, vestibular and cerebellar function. While reasonable, this explanation seems rather vague to us. Halpern also indicated that thresholds for hearing discomfort as well as somatic sensation changed, according to the viewing eye. These findings are bizzare and presently lack an organic explanation.

Bental and Hammond Tooke (1979) reported a case in which the symptoms were again provoked by monocular viewing, and also worsened by applying red filters to the eyes and improved with blue filters. It seems to us that this is simply a single unusual case presentation. The improvement with colored glasses, seems to us, to be pointing towards a psychological source of symptoms. In other words, we find this dubious.

More reasonably, some patients with congenital strabismus have latent nystagmus, a type of congenital nystagmus, that is eliminated by binocular viewing. This sort of patient might have a simlar presentation to "Halpern's syndrome", and should have nystagmus that changes direction accompanying their clinical exam. Similarly, patients with congential strabismus sometimes have anomalous retinal correspondance, and might develop spacial uncertainty with both eyes viewing, relieved by monocular viewing. This is not "Halpern's syndrome", of course, as it is improved by monocular viewing.