Vertigo is an underestimated symptom of ocular disorders: Dizzy children do not always need MRI

Vertigo, instability, dizziness, or equilibrium disorders are not usually c onsidered as consequences of ophthalmologic problems. We present data indic ating that ocular disorders call be responsible for these symptoms in child ren, In a population of 523 pediatric patients with vertigo or disequilibri um and referred for vestibular testing in our otolaryngology department dur ing a 5-year period, 27 children presented with normal vestibular and somat ic neurologic examinations but with ophthalmologic disorders (vergence insu fficiency or latent strabismus with binocular vision in 70% and anisometrop ia in 41%). These patients represented 24% of all vergence insufficiencies detected and 4% of all orthoptic examinations performed in the pediatric op hthalmology department. These ocular abnormalities were considered to be th e initial cause of the problems. in two thirds of these patients the sympto ms were completely resolved by simple ophthalmologic treatment. No other ad ditional tests, such as magnetic resonance imaging, were required. Therefor e we propose that every child complaining of vertigo or dizziness but with normal clinical somatic neurologic and vestibular examinations should have a complete ophthalmologic examination before additional, more costly, inves tigations. This should lead to better screening and more appropriate care o f ocular disorders in children and avoid unnecessary magnetic resonance ima ging. (C) 2000 by Elsevier Science Inc. All rights reserved.