What is Vertical Heterophoria?

Dizziness, lightheadedness, balance problems, anxiety, migraines – if these have become symptoms you know all too well, you might be suffering from Vertical Heterophoria (VH), a Binocular Vision Dysfunction caused by a misalignment of your eyes. And it can result from even a very slight misalignment that isn’t immediately noticeable to you or to people looking at you. When you look at the world through misaligned eyes, your body takes corrective measures to help you see clearly and in focus. This automatic reaction strains your eye muscles and leads to a slew of uncomfortable symptoms, including headaches and dizziness.

But dizziness while driving might not be your only symptom. Other symptoms can include:

  • Sensitivity to bright lights & glare, such as headlights, traffic lights, and signage
  • Blurred and/or double vision
  • Disorientation
  • Dissociation: not feeling present in your body, feeling “ungrounded”.
  • Problems with depth perception
  • Carsickness, dizziness when riding as a passenger, particularly in the back seat.
  • The feeling that things in your peripheral vision are moving when they really aren’t

Shoulder, Head and Neck Pain Symptoms

Unfortunately, the above symptoms aren’t the only ones linked to VH. Additional indications that you might have a binocular vision disorder include headaches pounding at your temples, forehead or at the back of your head. These headaches can vary in both intensity and general location. You could also experience pain whenever you move your eyes.

Additionally, those with VH often report experiencing pressure or a sensation of heaviness at the crown of their heads. This pressure can be compared to a sinus pain and can also throb its way down to your jaw region. Reports also include aching in your neck and shoulders due to a head tilt. This head tilt can be frequently quite obvious.

What Causes Vertical Heterophoria?

It is rare for a person to have right and left the side of their face looking identical – almost everyone has asymmetry. This means that one eye is higher than the other (obvious in a few, but almost imperceptible in most others), and sees an image slightly higher than the other eye. Your brain does not tolerate this misalignment and forces the eye muscles to realign the eyes so that one clear image is formed. Unfortunately, this ends up putting a lot of strain on your eyes, causing them to become overworked and fatigued, leading to symptoms that can disrupt your life.

How Do You Get Vertical Heterophoria?

Most often this is a condition you are born with. It may take years before symptoms occur, as the body will do the best it can to try and compensate for these problems. In some patients, this condition may be caused by head trauma, stroke, or neurological disorders.

There have been a number of patients who have developed VH (or had their VH worsened) due to a motor vehicle collision or other jarring incident (like falling) without documentation of a TBI. While the etiology of the VH in these situations is unclear, it is clear that the VH was precipitated (or worsened) by the incident because the symptoms started (or pre-existing symptoms were worsened) immediately after the incident.

How is Vertical Heterophoria Treated?

Vertical Heterophoria is treated by correcting the eye misalignment. To accomplish this, the optometrist has 2 treatment methods.  The first is a therapeutic prism glasses’ prescription which helps realign the eyes so that eyestrain and other symptoms are greatly reduced or eliminated.  The prism glasses will need to be worn to alleviate symptoms, and symptoms typically reoccur if the prism glasses are removed.  To permanently correct the problem so that prism glasses are usually not necessary, an optometric vision rehabilitation is recommended.


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