Let’s start with the most important, dizziness is not a disease. Dizziness is a form of physical disability where a person’s spatial perception and stability are compromised

In recent years, both physicians and the general public have become increasingly concerned about the consequences of brain trauma, including sports-related injuries or concussions, in both adults and children. As a result, optometrists are seeing a significant increase in the number of patients who suspect that their injury has caused many of the visual problems they suffer, including blurred vision, double vision, difficulty reading or seeing your electronic device, problems with balance and movement, disorientation in busy environments, and dizziness.

More information: The dangers of a blow to the eye

Every year, medical centers around the world receive millions of patients who have suffered a traumatic brain injury. Many of these individuals enter for care and often receive comprehensive rehabilitation services, including occupational, physical, speech, and cognitive therapy.

Often during such therapies, many of these patients complain of persistent symptoms of poor balance and dizziness. As a result, they are often referred to an optometrist for an comprehensive visual examination This is why it is important for eye care professionals to become familiar with the various causes of dizziness and to understand the relationship between the visual, somatosensory, and vestibular systems. Asking the right questions during the history will allow you to effectively assess and care for these patients.

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What information should be obtained from someone who suffers from dizziness

As I have told you before, dizziness is not a disease. It is a form of physical disability where a person’s spatial perception and physical stability are compromised. It is often perceived when there is an abnormal spatial sense, which is commonly associated with injuries and strokes, the latter frequently contributing to the feeling of lack of balance.

What are the causes of dizziness

Below you will find a list of the most common causes of dizziness:

  • Vertigo
  • Side effects of certain medications (anticonvulsants and antidepressants)
  • Anemia
  • Hypotension
  • Hypoglycemia
  • Migraines
  • Hormonal changes
  • The pregnancy
  • Displacement in motor vehicles, boats, airplanes
  • Panic attack
  • Heart attack (in its initial stage)
  • Disorientation with head movements
  • Age-related changes
  • Decompensated phoria

What questions should be asked of someone who suffers from marros

The visual system is of paramount importance in all functional aspects of life. The vision requires a dynamic interaction with our environment so that we receive quality feedback that helps us guide our actions in our day-to-day life. During a visual examination, it is essential to know the history of the patients accurately and in detail, since This information will be key to cataloging the origin of dizziness
and for this you will have to ask the person:

  • What medications are you taking?
  • If you drink and what is your consumption of caffeine, alcohol or nicotine?
  • If you take drugs or if you have allergies?
  • If you suffer from migraines?
  • If you have suffered a head injury (recently or in the past)?
  • If you get dizzy when walking along an aisle, in crowds, in wide open spaces, in moving vehicles?
  • If you have a history of anxiety or depression?
  • If you have suffered a hearing loss?

If the patient reports that «the room is spinning“Or you have that” head sensation, “consider vertigo (benign paroxysmal positional vertigo versus vestibular dysfunction). A feeling of loss of consciousness may indicate presyncope. Any “feeling of instability or imbalance ‘(feet versus head), consider possible vestibular dysfunction. Any symptoms that involve feeling disconnected or groggy, may indicate anxiety or depression, which are commonly seen in cases of mild traumatic brain injury.

Strategies During and After a Visual Exam with Someone Suffering from Dizziness


During the visual exam carefully observe the patient for any unusual posture of the head or body
(when walking to your refractive room and / or while sitting). Try to remember that after a traumatic brain injury, many patients experience an abnormal spatial sense. Symptoms often include poor balance and abnormal posture (a tendency to collide with objects, having a lateral skew when walking, dizziness, and a feeling of being “out of step” with one’s surroundings).

Patients with an abnormal spatial visual sense are known to have visual-motor problems associated with coordination when walking, with the eye-hand coordination, plus a misperception of depth
of objects in its environment. This abnormal visual spatial sense is one of the most common sequelae after a trauma.


As optometrists, we are in a unique position to effectively manage many of the causes of dizziness. For example, we must take into account the possible adverse effects of prescribing progressive lenses, fundamentally due to the peripheral distortion induced by the lateral aberrations of said lenses, which will significantly affect patients who have suffered a traumatic brain injury. In those cases, consider the alternative of prescribing single vision lenses.

Also, if you suspect that the person has spatial visual difficulties, perform an ocular occlusion and ask him to tell you what he watches as you walk through your office. During binocular testing, you may very well find that your patient has a vertical heterophoria, which could effectively compensate by prescribing a vertical prism.

I hope that this information, whether you are professionals or people who suffer from dizziness, will be useful to you. And if you are optometrists, if from now on if you come across a patient who complains of dizziness, remember that a careful analysis of his case and a simple examination and correction strategy will allow you to manage them effectively.

Original article: Demystifying dizziness, written by Eric Ikeda, OD, FCOVD, DPNAP, a member of the AOA

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