Dizziness and the Vestibular Ocular Reflex (VOR)

There are a lot of causes of dizziness. Dizziness is a vague word though, and can be used to describe a variety of symptoms. So when a patient tells me they are dizzy, I first clarify what type of dizziness because that gives me good insight to the problem at hand. There is the room-spinning dizziness that is most commonly associated with BPPV (the crystals in the ear). Then there is light-headed dizziness which may be a blood pressure issue, amongst other things. Then there is that feeling of being “off-kilter”, or a “wooziness”. This is the type of dizziness this blog will address. 

The vestibulo-ocular reflex (VOR) plays a crucial role in maintaining stable vision, particularly when the head moves. Imagine you're riding in a car, and you’re looking out the window at a tree. Now, when the car turns, you can still see the tree clearly, right? That’s because your eyes quickly adjust to keep the tree in focus, even though your head is turning. This reflex allows your eyes to adjust quickly and accurately in response to head movements, helping you maintain focus on an object despite the changes in your head's position. When there’s an issue with this reflex, it can lead to a condition called VOR hypofunction. 

VOR hypofunction refers to a decrease in the function of the vestibulo-ocular reflex. In simpler terms, it means that the system responsible for stabilizing your gaze during head movement isn’t working properly. This results in blurred vision, dizziness, and difficulty focusing on objects when you move your head.

The VOR works by detecting head movement via the vestibular system, which is part of the inner ear. By the way, this has nothing to do with hearing. The vestibular system sends signals to the eye muscles to adjust the position of the eyes, helping you maintain a stable visual field. When this process is disrupted, you may experience a variety of symptoms, especially when turning your head or performing activities that require quick eye movements.

I often liken this to a boat with 2 engines, one is 150 horsepower and the other is 50 horsepower. It would be hard to drive that boat straight. VOR hypofunction is a miscalibration of the reflex. This can cause blurred vision, difficulty focusing on an object, motion sensitivity, nausea, and impaired balance. You may even notice that you are veering to one side when walking. 

VOR hypofunction often occurs secondary to another issue. It can be as simple as dehydration. It often happens with someone who has been dealing with BPPV for a long time. Or, if you’ve become sedentary and are just not using the reflex much. Like a muscle, it atrophies in a sense. The good news is that it’s just a matter of recalibrating the reflex to fix it. This can be done with some simple exercises called “gaze stabilization”. 

If this sounds like you, I’d recommend getting on a call:

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