VISUAL VERTIGO -- THE BIG PICTURE
Timothy C. Hain, MD Page last modified:
November 28, 2019
Visual vertigo means that the cause of a spinning sensation, or more broadly, unsteadiness, is from the eyes.
As is the case for most physiological systems, there are three general classes of disturbance so we have 3 types of visual vertigo -- sensory, central, and motor.
- In sensory visual vertigo, the eyes are still but there is an inappropriate signal, or lack of a signal coming from the eyes.
- Tilting of one eye -- these sorts of problems can be detected with tests such as the Lancaster red/green test or retinal photography and similar methodology
- with respect to the other eye
- 4th nerve palsy (which can cause torsional diplopia)
- Oculomotor nerve or nucleus lesions
- Ocular muscle weakness or restrictions
- With respect to other sensors of vertical
- Anisometropia (difference in the size of images on one eye vs. the other)
- Post-cataract surgery -- one eye can see world with one lens, other has different lens.
- "mono-vision" -- one eye for near, another for far. Size of world depends on eye being used.
- Astigmatism -- size of world may depend on position of eye with respect to glasses.
- Progressive lenses -- size of world may depend on position of eye with respect to glasses.
- Visual loss such as in retinitis pigmentosa or near blindness
- In central visual vertigo, the inappropriate signal is from the brain.
- Oversensitivity to visual stimuli, such as in migraine associated vertigo (mav) or visual dependence. This is the main one.
- Some patients have "visual snow", which is due to hypersensitivity of their visual cortex.
- Seizure as in epileptic vertigo
- inversion illusions (mainly migraine again).
- Abnormal motion processing, such as palinopsia
- Halpern's syndrome -- unsteadiness based on viewing with one eye. This is of questionable significance.
- Posterior cortical atrophy -- mysterious disorder related to Alzheimer's disease with shrinkage of back part of brain.
- In motor visual vertigo, the eyes are moving, causing apparent movement of the world.
- Nystagmus syndromes such as
See this page for more information about visual dependence.
See this page for references about visual vertigo.