Timothy C. Hain, MD, • Most recent update: August 22, 2020
Normally people benefit from being able to see, including with two eyes vs. just one, and it helps them balance (e.g. Wu and Lee, 2015). Sometimes vision causes dizziness when it shouldn't (this is called visual vertigo). The concept of visual vertigo was first described by Darwin in 1797, according to Balaban and Jacob (2001). An alternative name, clever but little used, for visual vertigo is "See sick syndrome", or SSS. This is a term invented by Roderic Gillilan, O.D, an optometrist. The link https://www.seesicksyndrome.com/contains a description of how optometrists view visual vertigo.
Bronstein (1995) used the term "visual vertigo" for "visually induced vertiginous symptoms". He described a heterogeneous group of 15 patients, including several with brain disorders, and several with weakness or misalignment of their eyes, and reported typical triggers were "walking in supermarket aisles", visual moving surroundings during travelling in cars or trains, moving objects, disco lights, people walking, cars passing by, and in two people, simple movement of their eyes. He reported that they had "considerable sway induced by room motion", and dicussed the idea of visual dependence. Persons who are visually dependent orient their posture according to information from their eyes to a greater extent than others.
Patients with "visual vertigo" often complain of disturbances related to
- optic flow -- think grocery stores
- visual motion in general -- such as when driving.
- computer screens -- such as scrolling
- photosensitivity -- this really doesn't go along with the previous 3, but is a sign of migraine which is correlated.
This must be considered in the context that persons with dizziness may have
- nystagmus (involuntary jumping of the eyes)
- a tilt of the eyes (called ocular counterroll)
- asymmetrical or impaired vestibular reflexes
One must also consider that persons with dizziness may have ocular disorders such as:
- latent nystagmus or congenital nystagmus
- Anisometropia (i.e. difference in the optical power between the eyes)
- Abnormal sensory mapping of the eyes (e.g. after retinal detachment, or following correction of strabismus)
- Abnormal movement of the eyes, that may depend on the direction of gaze (i.e. ocular motor palsies, internuclear ophthalmoplegia)
- Abnormal position of the eyes with respect to each other -- this is called a "heterophoria".
- Various other types of binocular visual disturbance
- Disurbances of their vision from a disorder that impacts both the inner ear and the eye.
Nearly anyone might have psychiatric disturbances such as anxiety that cause them to be more reactive than other people. This observation has been the driver for creation of other symptom lists, with different acronyms (e.g. PPPD, BVD), claiming to be diseases.
When enumerates all of the possible disturbances, it is amazing that visual vertigo is not more common ! This likely from the amazing power of our nervous systems to adapt to a variety of sensory and motor issues involving balance.