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We all have different lenses when we look at a patient with dizziness. A neuro-optometrist would think of a midline shift and may prescribe yoked prisms. A neurologist wants to clear the brain for normal function. A family practice physician may wonder who to send their patient to. A chiropractor manipulates the neck while a physical therapist gives thumb tracking exercises and 'pencil push ups'. One test we all need to consider when evaluating a patient with dizziness is convergence.
Here is a young man of eleven that has a history of progressive dizziness that is brought on with reading. He gives us clues in this video as to what is going on. We get to see a simple and fast test to show what is causing Aidyn’s dizziness.
Dizziness can come from our inner ear or vestibular system, our eyes and even our neck. These systems are connected through a powerful reflex, the VOR (Vestibulo-ocular reflex). One test you should do to check eye coordination is convergence.
In Aidyn’s example we know that there is a convergence insufficiency present. This is because of ocular muscle trigger points to the ocular muscles of both eyes. The reason for these trigger points can be a neck issue and even a clenching problem. Aidyn also has poor sleep and his airway is affected due to a chronic sinus problem. He has recently had multiple sinus surgeries that preceded his symptoms of dizziness. We may have found the direct cause of dizziness but not the underlying reason why. This is a great example of why a medical team is needed to address these complex problems. One treatment may help in part but may not fully address the overall underlying problem.
Tips for Convergence Testing
Go slowly and repeat
Watch the eyes and look for eye drift and nystagmus
This test may bring on dizziness as well as eye pain and headache
Ocular muscle trigger points can occur and have different causes.
Eye exercises may help but may not address the underlying cause.
Here is some deeper information on what and how we test the eyes for ocular muscle issues and poor ocular coordination.
