Vestibulo-ocular reflex – A narrative review

The vestibulo-ocular reflex (VOR) causes movements of the eye that are intended to compensate for head and body movements so that vision remains stable on the retina. VOR helps to stabilize the retinal image by rotating the eyes to compensate for movements of the head. The VOR keeps us steady and balanced even though our eyes and head are continuously moving during the performance of actions. The VORs are driven by signals coming from vestibular labyrinths and use subcortical, short-latency pathways from vestibular afferents to the extraocular motor neurons. The relatively simple neural architecture of these reflexive responses, coupled with their stereotyped but adaptable nature, makes them ideal to understand simple sensorineural transformations. Without VOR, when an individual walks down the street, it is difficult to read signs or even recognize faces. Even an inaccurate VOR can result in a slip of visual image concerning photoreceptors, causing blurring of the images. If the VOR is injured, the retinal slip occurs which causes instability in gaze during rapid head movements. The disruption of the VOR results in oscillopsia and abnormal nystagmus. Oscillopsia causes blurred vision when the head is in motion and objects appear to jiggle and bounce as this object does not fix at one point in the retina. The objective of this review article is to discuss the anatomy of VOR with its bedside examinations, clinical implications, and management of VOR failure.