Vestibular disease

Visually induced dizziness

This information is intended as a general introduction to this topic. As everyone is affected differently by balance and dizziness problems, you should speak to your doctor for individual advice.

For reasons of better readability, the generic masculine is used and the simultaneous use of the language forms male, female and diverse (m/f/d) is dispensed with. Unless otherwise indicated, the personal designations used in this patient information refer to all genders.

What is visually induced vertigo?

Visually induced vertigo is not a disease. It is a generic term for a group of symptoms caused by certain vestibular disorders.

Visual induced vertigo is chronic dizziness or gait instability caused or aggravated by large surfaces with complex patterns or movements. These can be, for example, supermarket shelves, moving traffic or movies on a large screen.

Visual vertigo can be very uncomfortable and cause problems with everyday activities, work, social life and mental health.

Visually induced vertigo is also known as visual vertigo, supermarket syndrome or visual-vestibular mismatch.

Cyber sickness, nausea or discomfort triggered by viewing moving digital content on devices, is a subset of visually induced dizziness.

Summary

What causes visually induced vertigo?

Visually induced vertigo usually occurs as a result of a disorder of the vestibular system.

These faults can be caused by

  • an acute head injury
  • Acute benign paroxysmal positional vertigo (BPLS)
  • acute vestibular neuritis
  • Persistent postural-perceptual dizziness (PPPD)
  • Vestibular migraine

It is also a common symptom of whiplash injuries.

Why does visual vertigo occur?

There are several theories as to why visually induced dizziness occurs. Most researchers believe that it is caused by a malfunction or contradiction between the different structures of the balance system in the brain, similar to motion sickness. Others believe that vestibular disorders cause the brain to rely too much on visual cues to maintain balance (visual dependence).

The brain's balance system combines information from many sources, including:

  • The vestibular system (the semicircular canals and macula organs in the inner ear), which perceives head movements and changes in the speed of head movement
  • The visual system, i.e. the eyes
  • The proprioceptive system, which sends signals about position, pressure, movement and vibration from the legs and feet and the rest of the body to the brain

At any given moment, your brain evaluates all these different signals and decides which are more important and reliable at that moment. For example, when you are watching a movie, the visual system says that there is movement, but the vestibular and proprioceptive systems say that your body and head are not moving. Normally, your brain takes in all these signals and assesses the situation correctly: You see movement, but your body is not moving.

In visually induced vertigo, the brain relies too much on information from the visual system and not enough on the vestibular and proprioceptive systems. This is sometimes referred to as "visual dependence". If there is a contradiction between the visual system and the other systems, the brain is more likely to believe the visual system and decide that you are moving when you are not. The contradiction between the signals can lead to dizziness or unsteady gait.

Some studies have found slight differences in the connectivity of brain areas in people with visually induced vertigo. This could mean that some people are more susceptible to visual dependence and more likely to develop visually induced vertigo following a vestibular disorder.

Visually induced vertigo is usually triggered by one or more of the following situations:

  • Car, bus or train journeys (motion sickness)
  • Visually animated environments, such as a supermarket
  • Movements on a large surface, e.g. a movie in the cinema / large television or the sight of clouds, leaves or water
  • Scroll on a cell phone, tablet or computer

During an episode of visually induced vertigo, the following symptoms may occur:

  • Dizziness
  • Gait instability
  • Drowsiness
  • Disorientation
  • Nausea
  • Vomiting
  • Sweating
  • Salivation
  • Tiredness
  • Blowing

The symptoms are compared to seasickness or drunkenness.

Visually induced vertigo does not usually cause rotational vertigo. There is also no oscillopsia (shaky vision).

People with visually induced vertigo may be afraid of situations that could trigger their symptoms.

Diagnosis of visually induced vertigo

Visually induced dizziness can be caused by various vestibular disorders. Therefore, you should consult a neuro-otologist or ENT doctor who specializes in dizziness. These specialized doctors will take a thorough medical history, perform a neurological examination and various tests to assess the function of your vestibular system.

You will probably have some of the following diagnostic tests done:

  • Hearing tests and vestibular function tests
  • Balance tests that measure what happens when you get less input from your visual or proprioceptive system, e.g. by asking you to stand on a soft surface or moving platform with your eyes closed
  • Imaging (MRI scan)

Treatment of visually induced dizziness

The treatment of visually induced vertigo depends in part on what is causing it. If it is caused by an underlying condition, such as vestibular migraine or persistent postural-perceptual dizziness (PPPD), treating this condition may alleviate some of your symptoms.

You also need special help with visually induced dizziness, e.g. vestibular rehabilitation and visual habituation exercises at home. The aim of these treatments is to retrain your vestibular system and reduce dependence on the visual system.

A study has shown that the drug acetazolamide can help with visually induced dizziness. However, further research is needed before this drug can be widely used.

Therapy option

Dealing with avoidance behavior and fears

It is important that you continue with your normal daily activities. Don't try to avoid things that trigger dizziness. You need to slowly get used to them again.

But don't overdo it. This can make your symptoms worse. Vestibular rehabilitation can help you by exposing yourself to dizziness-inducing situations in a controlled manner.

If you are anxious about your symptoms, talk to your doctor about how to manage them. For people with visually induced vertigo, which is part of persistent postural-perceptual dizziness (PPPD), cognitive behavioral therapy (CBT) can be an important part of treatment. It can help to manage anxiety, cope with symptoms and gain confidence.

Therapy option

Vestibular rehabilitation

Vestibular rehabilitation is an exercise therapy. Its goal is to help your brain relearn balance control and respond to signals from the visual and vestibular systems. A certified IVRT® dizziness and vestibular therapist can help you create an appropriate program for you and set treatment goals.

Therapy option

Visual habituation exercises

A certified IVRT® Dizziness and Vestibular Therapist can put together visual habituation exercises for you to do at home. These exercises use videos that are designed to make you dizzy. You should start slowly and gradually with simple videos. With practice, you can then work your way up to longer and more complex videos.

What happens next?

What you can expect in the future.

Cyber sickness has a similar clinical picture to visually induced dizziness. With cyber sickness, dizziness is caused by virtual reality (VR). As VR devices become more widespread, cyber sickness is also becoming more common. As a result, more research is being conducted into the underlying causes of visually induced vertigo. As technology advances, we may learn more about how to prevent and treat the disorder.

In order to keep this patient information as short as possible, we have not included a detailed list of references. However, this can be requested at any time at info@ivrt.de.

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