Vertical Heterophoria

Vertical heterophoria (VH) is a binocular vision disorder in which one eye sits slightly higher than the other. The misalignment can be very small, but the eye muscles strain and overwork all day to pull the two images back together — and that constant effort is what produces the headaches and dizziness. Because those symptoms do not feel like eye symptoms, VH is sometimes mistaken for vertigo or a migraine disorder.

Symptoms tend to come in waves through the day: you can feel 100 percent one moment and as though you have been locked in a centrifuge the next. Headaches and dizziness are often set off by a change of position or motion — standing quickly, turning the head side to side, straightening up after bending over, riding in the passenger seat, rounding curves in the car, or highway driving with traffic whizzing past. Alongside those triggers, people describe nausea, motion or car sickness, and an unsteady walking stride — drifting to one side going down a hallway, or feeling pulled toward whoever is walking next to them, as if by a magnet.

Shoulder, Head and Neck Pain

The head and neck take a share of the load. Headaches can pound at the temples, the forehead or the back of the head, and they vary in both intensity and location from day to day. Moving the eyes themselves can hurt. Many patients also report pressure or a sensation of heaviness at the crown of the head — closer to sinus pain than to a typical headache — that can throb its way down toward the jaw.

Aching in the neck and shoulders is common too, because the body compensates for the misalignment with a head tilt. That tilt is frequently obvious enough that family, teachers or a physical therapist notice it before anyone connects it to the eyes.

Driving and Anxiety

Driving is where VH often becomes impossible to ignore. Stationary objects at the edge of your vision — signs, poles, parked cars — can read as moving images. Coming to a complete stop can be unnerving: the dizziness makes it seem as though the sign is drifting, or that the car is rolling backward while your foot is on the brake. Over time the worry about becoming dizzy behind the wheel becomes its own problem, and that anticipatory anxiety often eases once the underlying misalignment is treated.

The same visual overload shows up away from the car. Rooms with very tall ceilings can feel unsettling, because there is so much visual space to take in at once that it tips into disorientation, and scanning the faces of people in a packed crowd can bring on dizziness.

How Vertical Heterophoria Is Treated

Treatment corrects the misalignment, and there is usually more than one way to get there. Therapeutic prism glasses can reduce or eliminate symptoms such as headache, dizziness and eye strain by realigning the images before they reach the eyes. The trade-off is that prism has to be worn most of the time to do its job, and symptoms can be expected to return when the glasses come off.

Vision therapy is the more permanent route: a doctor-prescribed regimen of in-office and at-home exercises that strengthens the coordination between the brain and the eyes so the visual system holds alignment on its own. The two are not mutually exclusive — prism can carry you comfortably through therapy — and our comparison of prism glasses and vision therapy walks through how we choose.

If this sounds familiar, the symptom checklist is a quick place to start, and our pages on dizziness, headaches and binocular vision dysfunction cover the wider picture. You may also want to read whether vision therapy helps motion sickness and dizziness and the connection between migraines and binocular vision disorder.

Care starts with a comprehensive developmental and binocular vision evaluation that pinpoints exactly what's happening. From there, Dr. Murray builds an individualized plan — which may include lenses or prism, in-office vision therapy, and coordination with your other providers — at our Boynton Beach and Boca Raton offices.