Moving Eyes Making Me Dizzy

Dizziness and vertigo affect about 15% to 20% of adults per year. Although often used interchangeably, dizziness and vertigo are considered distinct sensations. Dizziness is a general term that may have different meanings depending on the person. The term could mean that a person feels light-headed, unsteady, or faint. People experiencing vertigo may also describe the sensation as dizziness, but vertigo is more specific.

The exact definition of vertigo is a false sense of movement, described by some as a sensation that they are spinning or that the world around them is spinning. Although vertigo fits under the umbrella of dizziness, it is the only cause of dizziness that causes this spinning sensation. Dizziness with eye movements can manifest as lightheadedness, unsteadiness, or vertigo. People with these symptoms should discuss them with a health professional because they may indicate an underlying disease. This article will review how eye movements are related to dizziness, conditions that commonly cause this symptom and possible treatment strategies.

How Eye Movements Cause Dizziness

Knowing how the eyes usually move is necessary to understand why people may experience dizziness during eye movement. The eyes move in four basic ways: saccades, smooth pursuit, vestibulo-ocular movements, and vergence movements.

Saccades

Rapid eye movements that abruptly alter the point of eye fixation are called saccades. Saccades are often described as ballistic movements because the eyes are unable to adjust to a new target once the movement starts. Saccades can be voluntary but also occur reflexively whenever the eyes are open. These eye movements can be small (reading a book) or large (looking around a room).

Smooth Pursuit

Smooth pursuit movements are smaller than saccades, and they are executed to focus a moving stimulus centered on the fovea — the center of the eye’s macula where eyesight is sharpest. The macula is a small area in the retina (back of the eye) that helps people see detailed objects, such as faces and written words. Since people can choose whether or not to track a moving stimulus, smooth pursuits are voluntary. However, most people end up performing a saccade when they attempt to make smooth pursuit movements without a moving target to follow.

Vestibulo–Ocular Movements

Vestibulo–ocular eye movements compensate for head movements by stabilizing the eyes relative to their surroundings. These movements are reflexive, meaning they are performed subconsciously. The inner ear’s vestibular system, which is responsible for keeping the body balanced, detects subtle, quick changes in head position, leading to rapid corrective eye movements. The semicircular canals — bony tubes that are a part of the vestibular system and sense head position — tell the eyes to move in the opposite direction of the head to remain fixated on a stationary object while the head is moving.

Vergence Movements

Vergence movements keep targets that are located at different distances from the observer aligned with each eye’s fovea. Unlike the first three movement types, vergence movements are disconjugate — moves the eyes in different directions. In particular, they cause the eyes to rotate toward or away from each other to focus on a closer or farther object. Vergence movements are one of three visual responses that are triggered by interest in a nearby object. The other two are the accommodation of the lens (object focus) and pupil constriction.

Eye Movements and Dizziness

By using these specific movements, the eyes work together with the vestibular system and proprioceptors (nerve sensors) in the legs and feet to maintain balance. Dizziness or vertigo may develop if any of these three components stops working properly or does not communicate with the others. When someone experiences dizziness, unsteadiness, and disorientation due to visual triggers, including eye movement, it is called visual vertigo.

The remainder of this article will review the most common medical conditions that are associated with dizziness and visual vertigo, along with steps to manage them.

Ocular Dysfunction

The most common conditions that cause dizziness with eye movement can be divided into two groups — those that occur due to ocular dysfunction and those that develop as a result of vestibular dysfunction. Ocular dysfunction refers to conditions that directly affect eye function.

Binocular Visual Dysfunction

Binocular visual dysfunction (BVD) is a common cause of dizziness with eye movements due to ocular dysfunction. BVD affects about 20% of people in the United States (US). People with BVD are often misdiagnosed at first with vestibular migraines, which is a rare condition. A common subtype of binocular dysfunction is convergence insufficiency — a condition in which the eyes cannot work together to focus on objects at close distances.

BVD develops due to eye misalignment, where the eyes send two images to the brain that are positioned differently. When this happens, the brain cannot correctly process the situation and signals the eye muscles to compensate for misalignment with realignment. This forced realignment only works temporarily and leads to further misalignment.

The cycle that results from misalignment and realignment leads to eye muscle fatigue and the sensation that objects are moving. The symptoms include:

• Dizziness
• Visual Vertigo
• Eye strain
• Headaches
• Nausea
• Anxiety
• Light sensitivity
• Balance issues
• Frequent head tilting
• Motion sickness
• Neck pain
• Difficulty reading and learning

BVD can be linked to certain conditions, such as traumatic brain injury (TBI) and stroke. Additionally, some people are born with facial asymmetry (one eye is higher than the other), eye muscle issues, or nerve problems that lead to BVD. Treating BVD requires correcting the eye misalignment with micro-prism lenses. These lenses work by bending light to realign the images produced by both eyes.

Traumatic Brain Injury

About half of people with TBI experience dizziness and balance problems during their recovery period. Symptom severity depends on TBI severity, referring to which part of the brain was injured, additional injuries, and possible interaction with medications. There are several causes for balance problems after TBI, including vision problems, but BVD and inner ear problems are the most prominent causes of post-TBI dizziness.

Stroke

After a stroke, people may experience dizziness related to eye movement due to nerve damage. If the blood clot that caused the stroke affects the eye nerves, eye movement will be affected. This damage can manifest as BVD or other conditions, including nystagmus — involuntary and rapid eye movements.

Nystagmus

Nystagmus is a condition that is characterized by rapid, repetitive, and uncontrolled eye movements that can be congenital or acquired. Congenital nystagmus usually affects both eyes and most commonly causes blurry vision. Symptoms of congenital nystagmus typically start between six weeks and three months of age. Acquired nystagmus develops later in life, is generally caused by an underlying medication condition or medication, and can affect one or both eyes. People with acquired nystagmus often describe “shaky” vision as the main symptom.

The rapid eye movements caused by nystagmus commonly lead to vertigo and dizziness. People may also experience light sensitivity, nighttime vision problems, and difficulty with balance. Although nystagmus itself is not dangerous, the condition can be a sign of a serious underlying brain condition, such as a stroke, a brain tumor, head trauma, or certain inflammatory diseases. A medical professional should evaluate people with new onset nystagmus to rule out these potentially life-threatening conditions.

Vestibular Dysfunction

Vestibular dysfunction refers to balance difficulties that result from peripheral injury to the inner ear, central injury to the central nervous system (CNS), or both. Both central and peripheral vestibular dysfunction can lead to nystagmus and dizziness when moving the eyes.

Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) accounts for 20% of individuals who experience severe dizziness/vertigo, making it the most common cause of peripheral vestibular dysfunction. BPPV causes short episodes of dizziness or vertigo that are usually one-sided and develop due to abnormal inner ear crystal movement. Normally, inner ear crystals are anchored to the inner ear. When they become dislodged, they tend to move to the most dependent position within the semicircular canals. This movement is registered by the inner ear machinery as movement, causing vertigo.

Typically, symptoms of BPPV are most noticeable with changes in position and upon waking up in the morning. BPPV is usually diagnosed through a comprehensive exam by a medical professional. Certain physical exam maneuvers can elicit symptoms of BPPV that help confirm the diagnosis. One maneuver used during the exam, the Epley maneuver, can also be used to treat symptoms of BPPV at home or during physical therapy.

Ménière Disease

Ménière disease is another common condition that causes peripheral vestibular dysfunction. Usually, this disease is characterized by vertigo, hearing loss, and tinnitus (ringing in the ears). Vertigo typically occurs in episodes that last minutes to hours. The exact cause is unknown but is thought to be related to volume disturbances within the endolymphatic sac — an inner ear organ filled with fluid called endolymph. Ménière disease usually affects one side. However, in about 17% of individuals diagnosed with this condition, bilateral (affecting both sides) symptoms develop.

Importantly, Ménière disease can manifest as a vestibular variant that does not cause hearing loss or tinnitus. This variant can be difficult to differentiate from a vestibular migraine — a migraine that is characterized by balance and dizziness symptoms with or without headache.

Vestibular Neuronitis

Another cause of vertigo is vestibular neuronitis — inflammation of the vestibular nerve. Experts believe acute viral or post-viral inflammation causes vestibular neuronitis. However, if the inflammation also affects the cochlea — the part of the inner ear containing the organ of Corti that responds to sound vibrations — the condition is called labyrinthitis. In addition to vertigo, people with labyrinthitis experience hearing loss.

Transient Ischemic Attack and Stroke

In contrast to peripheral vestibular dysfunction, the most common causes of central vestibular dysfunction are transient ischemic attack (TIA) and ischemic stroke involving the vestibular nerve tracts, cerebellum, or brainstem. The cerebellum is the part of the brain that is primarily responsible for maintaining balance. TIAs and ischemic strokes are caused by blood clot formation in the brain’s blood vessels, which hinders adequate blood flow to the affected part of the brain.

TIAs, as the name suggests, are transient, meaning that the blood vessel blockage is temporary and the symptoms resolve. Ischemic strokes are permanent blockages that cause irreparable damage and prolonged symptoms. Central vestibular dysfunction causes similar symptoms as peripheral vestibular dysfunction, including vertigo, nausea, vomiting, gait difficulties, and nystagmus. It is important to recognize these symptoms as possible signs of a stroke to promote immediate medical care.

Treating Symptoms with Physical Therapy

The first step in treating dizziness with eye movement is identifying and addressing its underlying cause. Although many of the conditions described here cause persistent symptoms despite appropriate medical management, treatment with physical therapy can provide additional relief. For both ocular and vestibular dysfunction, vestibular rehabilitation can be beneficial.

Vestibular rehabilitation involves exercises that are designed to relieve dizziness and imbalance. In order to increase exercise tolerance, these exercises focus on building up speed and intensity slowly over time. As a result, vestibular rehabilitation programs require a significant investment of time. Vestibular rehabilitation aims to repeatedly stimulate the vestibular system and increase the brain’s ability to compensate for head and eye movements without causing dizziness.

At FYZICAL Therapy & Balance Centers, expert physical therapists are available to determine eligibility for vestibular rehab and guide people through the program. When done correctly, vestibular rehabilitation can markedly improve the quality of life for people who are living with dizziness. Exercises to expect when receiving vestibular rehabilitation at FYZICAL include eye movement control, balance retraining, strengthening, and stretching.

Summary

Feeling dizzy with eye movement can be disorienting and distressing, and identifying the underlying cause is essential for appropriate management and symptom relief. Physical therapy offers effective symptom management for people with chronic dizziness related to ocular or vestibular dysfunction. By increasing a person’s tolerance to head and body movement, vestibular rehabilitation and other balance-oriented physical therapy programs can improve a person’s ability to move the eyes without becoming dizzy.  If you want to learn more about physical therapy options to improve balance and dizziness, call FYZICAL today.

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