Vertical heterophorias are frequently overlooked and underdiagnosed. This type of vertical misalignment of the eyes is subtle and cannot be seen with the “naked eye”. Binocular vision testing uncovers this subtle issue with how the eyes aim and coordinate as a team. Our eyes should aim at the same point in space at the same time. If an eye misalignment occurs, our brain develops symptoms to communicate the lack of proper eye aiming.

Vertical heterophorias commonly lead to dizziness, imbalance or feeling unsteady, headaches, neck pain, anxiety, double vision, nausea, motion sickness, and reading/learning/work difficulties. One aspect to look for is a head tilt, either slight or extreme. A head tilt to the right or left side can indicate the presence of a vertical heterophoria.

Because of how common vertical heterophorias can be, I test vertical eye alignment on all of my patients. Treatment frequently includes prism lenses and vision therapy, with the ultimate goal of eliminating symptoms. Be aware that vertical heterophorias may be misdiagnosed as migraines or vertigo. This is why it is essential to fully evaluate binocular vision when symptoms of dizziness, headaches, motion sickness, or more develop.