How should I approach and manage adult-onset oscillopsia?

Abstract

Oscillopsia is the sensation of illusory movement within the visual percept leading to a degradation of visual functioning and quality of life. The constellation of conditions manifesting with oscillopsia marks the overlap between ophthalmology and otorhinolaryngology. The purpose of this article is therefore to review the aetiologies of oscillopsia and provide pathways for investigation and treatment of processes that associate oscillopsia with intrusive ocular movement and for processes manifesting as oscillopsia in the absence of intrusive ocular movement. Points for referral are also included for the diagnoses that are more appropriately investigated and managed by allied medical specialties.

Fig. 1. Diagnostic Flowchart for Oscillopsia (VOR: Vestibulo-Ocular Reflex, BPPV: Benign Paroxysmal Positional Vertigo).

With reference to VOR Impairment, ‘mobilising’ refers to both walking and riding in a vehicle over an uneven surface. In addition, conditions with ‘manifest’ ocular movements can have a transient component and therefore may not necessarily be visible at the first clinic attendance.