Visual vertigo is the feeling of dizziness or disequilibrium that is triggered by rich visual conflicts or intense stimulation of the visual system. Symptoms of visual vertigo are frequently correlated with underlying peripheral vestibular disorders, stemming from a difficulty pairing visual and vestibulo-proprioceptive systems. 

Each person has three systems: balance, vision, proprioception, and vestibular. These three systems work simultaneously to help us walk, dance, and stand. When visual vertigo is involved, your body has become overly reliant on the visual system and not reliant enough on the proprioceptive and vestibular systems. 

You can test for balance system dependence with the M-CTSIB test, which examines which balance systems you have used and which ones are more difficult for you. Visual dependency becomes problematic when you have difficulty walking in the dark and on uneven surfaces, or if you become disoriented or dizzy with visual stimuli. 

Visual dependency and dysfunction is what makes you feel dizzy watching movies on a big screen, why you feel off balance when a train goes by, or when busy patterns make you feel nauseous. Increased visual dependence is not problematic without an underlying vestibular dysfunction. If there is a history of a vestibular condition such as Vestibular Neuritis, Vestibular Migraine, Meniere’s Disease or otherwise, it is possible that the brain has unlearned use of the vestibular system, and overuse/increased dependence on visual systems. 

If you are watching a movie on TV the characters are moving, but you are not. If you feel like you’re moving, when you’re in fact on the couch, your vestibular and proprioceptive systems are not sending the right signals to your brain. Your visual system has taken over in this situation, it is overriding the signals that say “I am sitting still” and telling your brain that you’re moving. This is not only incorrect, but also incredibly uncomfortable. Physical therapy can help you relearn use of your vestibular and proprioceptive systems to decrease imbalance, disorientation, and dizziness that’s involved with optic stimuli.  

Symptoms and Diagnosis

Symptoms of visual vertigo will appear after an insult or injury to your vestibular system. 

These symptoms include, but are not limited to:

  • Lightheadedness
  • Dizziness
  • Nausea
  • Sweating
  • Vomiting
  • Disorientation
  • Tiredness
  • Becoming pale
  • Disequilibrium
  • Heavy eye feeling
  • Overactive or large postural corrections to small or large optokinetic simulation

These symptoms are often triggered by:

  • Watching TV or a movie on a large screen
  • Scrolling on a phone, tablet, or computer
  • Playing video games
  • Walking through a crowd
  • Driving in traffic 
  • Walking in the aisles of the grocery store or other large store
  • Being in a car, bus, or train
  • Driving by rows of vines or plants in agricultural areas

Having disequilibrium, imbalance, nausea, or lightheadedness with optokinetic stimuli that is diagnosed as visual vertigo must be preceded by an acute or chronic vestibular diagnosis. If you have not been diagnosed with a vestibular disorder, you may still experience difficulties with visual disturbances and stimuli, but it is not necessarily visual vertigo. 

A history of one or more of the following:

  • Head injury or concussion
  • Benign Paroxysmal Positional Vertigo
  • Persistent Postural-Perceptual Dizziness (PPPD)
  • Meniere’s Disease
  • Vestibular Neuritis
  • Vestibular Migraine

Treatment

Treating Vestibular Vertigo is multifaceted. The treatment should be based on treating the underlying condition and simultaneously treating the visual dependence in your balance system. If you have a diagnosis like Vestibular Migraine or Meniere’s Disease, changing your die and taking prescription medication will effectively accompany Vestibular Rehabilitation Therapy in feeling like yourself again. It is vital to treat both the underlying condition and the remaining symptoms to ensure that the symptoms of Visual Vertigo will decrease and that they will not return with a flareup of the underlying condition. 

Physical Therapy

Seeking a Vestibular Physical Therapist is essential to healing. The objective of Vestibular Rehabilitation Therapy (VRT) is to teach your brain how to appropriately respond to visual stimuli. Your Physical Therapist will determine which tasks, measures, and exercises are difficult for you, and what you may be avoiding participating in during your daily activities. Before designing your healing program, your PT should ensure that it is applicable to you and your goals. Discuss with your Physical Therapist the tasks that you are avoiding and hesitant about, and what you would like to improve. Vestibular Rehabilitation Therapy is effective in treating Visual Vertigo, and your Vestibular Physical Therapist will work with you closely to challenge our visual and vestibular systems to help you feel like your best self!

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