My team and I are seeing more and more people with blurry vision and when you talk to some of the patients it’s clear that the main problem that they have is actually gaze instability. Gaze instability means that the visual field is not stable. Vision is blurry or things in your vision field are moving.
If somebody has blurry vision the first thing to do is to go to an ophthalmologist. I prefer patients get an eye examination with a retinal specialist. However many times the patient will come back to us and say the eye doctors did not find anything, the structure of the eye is fine. No one know then what is causing the gaze instability.
Some people will go to a balance center for exercises and other therapy that can improve their gaze instability. However, many times health providers do not explore neck instability as the cause of gaze instability or the blurry vision and the patients do not get the hoped for results.
Procedures could help stabilize the cervical spine would stabilize vision.
In November 2024 surgeons writing in the North American Spine Society Journal (1) examining outcomes of cervical laminectomy and fusion and cervical laminoplasty for cervical spondylotic myelopathy and myeloradiculopathy found the laminectomy and fusion procedure may preserve horizontal gaze better than laminoplasty. This would suggest the cervical fusion better stabilized the spine and therefore stabilized the gaze. The further suggestion would be that any procedure that helps stabilize the cervical spine would stabilize vision.
We do tests discussed below that can suggest ligamentous cervical instability can cause blurry vision or gaze instability.
There’s all different kinds of blurry vision so these are some of the names and all of these things potentially could be from a neck problem and the neck problem specifically blocking the jugular vein which has a lot of detrimental effects and give all kinds of visual distortions.
- Kaleidoscope vision (Scrambled vision that can be intensely colorful as if you were looking through a Kaleidoscope )
- Blood Flow Issues:
- Sympathetic Nerve Stimulation:
- Diplopia: Double vision.
- Scotoma (An enlarging blind spot in the central vision.)
- Visual Snow – Visual snow syndrome is something that many patients describe to us as ONE of their many symptoms.
- Palinopsia (seeing an image even after looking away from it.)
- Eye Floaters.
- Photopsia (seeing flashes of light without an external light source.)
How vision works
Images from the pupil hits the retina and then it’s transmitted electrically through the optic nerve to eventually the visual cortex in the occipital lobes of the brain. You actually don’t see until your brain sees the image. Any disruption of the transmission of the image between retina and brain is going to distort the vision. If somebody has blocked jugular veins, it’s increasing the pressure on the brain and that could affect vision because it affects the optic nerve, it affects the lateral geniculate nucleus and it can affect the occipital lobes.
Any nerve problem to the eye muscles will cause the eye to distort. If one eye looks inward and the other eye is looking straight ahead, it’s a sign that there’s a cranial neuralgia which can be from a neck problem. One of the main nerves that innervates the muscles of the eye is the Oculomotor Nerve and this explains the neurology part of the problem. Hauser’s law number two is that if a person has a symptom a chronic symptom that is elusive like the cause of vision problems that cannot be solved, the neurology will lead to ligamentous cervical instability the nerves that innervate. The muscles to the eye originate in the brain stem. The brain stem is just above the upper cervical region so any sort of ligamentous cervical instability can block the cerebral spinal fluid, can block the jugular veins, can increase the fluid onto the brain stem and could cause a problem in the nerve transmission of cranial nerve number three, and cranial nerve number four, cranial nerve six.
Etiology of eye diseases
Ligamentous cervical instability can cause a compression or narrowing of the internal jugular vein preventing the fluid from getting out of the brain and we have to remember that the eye is in the brain. Anything that affects the brain could affect the eye, If the episcleral veins that drain the eye can’t drain, all the fluids primarily going out the jugular veins are blocked, there is going to be increased pressure of all the veins that drain the eye, toxins proteins and inflammatory substances start accumulating in the eye which of course can give blurry vision and ultimately you’re going to get high eye pressure
We document ligamentous cervical instability by digital motion x-ray where we take basically a movie of the vertebrae and we have the person move and what we normally find in people who have gaze instability and blurry vision is that the vertebrae are moving excessively and when vertebrae move excessively, important structures such as the spinal cord, the vagus nerve, the jugular vein, the superior cervical sympathetic ganglion that’s related to pupil dilation
Cranial nerve palsy, disruption to the nerve supply to the various eye muscles, in children common if the child is addicted to electronics. Again according to Hauser’s law number two you got to follow the neurology and the neurology of this leads to ligamentous cervical instability.
Neck instability consequences
Ligamentous cervical instability can cause the ophthalmic artery to spasm which is what I believe occurs when somebody has Amaurosis fugax. A condition where sight is lost in one eye typically during migraines. Also common is blurry vision with migraines. This suggests you have blurry vision when you have migraine headaches. Especially if you have cracking, clicking, popping in the neck and you have neck pain.
The superior cervical sympathetic ganglia is where the nerve tract that dilates the pupils runs. If you notice light sensitivity it’s likely that you have some ligamentous cervical instability. We do a test called a pupilometer so we can document this and then as the person’s getting treated we can see how the pupils are now reacting.
Internal jugular vein
Internal jugular vein compression increases the cranial pressure on the brain and that ultimately will lead to increased eye pressure causing cerebral spinal fluid to accumulate around the eye nerve. We we document this by measuring the optic nerve sheath diameter. Abnormalities can cause visual symptoms including gaze instability.
What does this image suggest? In this ultrasound image, the swelling of the optic nerve is clear compared to a normal optic nerve. A common but not as commonly diagnosed cause of swollen optic nerve and problems of vision is increased intracranial pressure from cervical spine instability.
This is a pictorial of somebody with bad posture and ligament injury in the neck. Eventually vertebrae go forward it causes compression of the various structures in front of the neck the significant structures in front of the neck is the jugular veins those are the main drainage ports to the brain and the superior ganglion where the nerve cell bodies of the Vagus nerve are located. The superior cervical sympathetic ganglion which dilates the pupils and is very important to the eye. If you think about it, this is where it is determined how much light goes into the eye. The superior ganglion sits right at C2 C3 so any type of ligament damage is going to cause vision problems.
Most of the jugular vein compression is at the atlas or C1 and the forward head posture or cervical dysstructure is the process that causes it and then when you get ligament damage basically the Suboccipital Muscles, the very small muscles at the top of the spine where the head hits the cervical vertebrae those get really tense and is a clue to cervical instability caused by ligament damage.
Unblocking fluid backup
We unblock or help the person unblock the jugular vein flow by correcting the neck curve and stabilizing the neck and showing them what positions they need to have the computer, the cell phone, sleeping positions. As the fluid returns to normal flow, the optic nerve sheath has the normal amount of fluid, then transmission of the image is more normal
Draining the episcleral veins
The episcleral veins that drain the eye can be blocked and cause a chronically dilated pupil. Fluids accumulate in the eye which I just call a polluted eye ecosystem with toxins that accumulate in the eye. This can happen to the eye well macular degeneration, retinopathy, and cataracts, this blockage again can possibly be from ligamentous cervical instability leading to eye pathology and some of these things you
High eye pressure – the eye is getting squished
Glaucoma is when the optic nerve head is affected so you can start to see that there’s something going on in the optic nerve head by the fluid accumulation and the question is why is fluid accumulating there I would say well it’s because the eye can’t drain properly because the jugular veins are compressed and then when that fluid the cerebral spinal fluid accumulates you then get eye flattening – the eye is getting squished.
Prolotherapy and curve correction
- Removing compression
- the more a person moves their neck right they get worse vision when you have gaze instability normally the activities that move the head the most they give the worst symptoms.
A cervical spine in proper dynamic cervical anatomy and alignment involves three primary parameters: alignment, curve, and stability. Ligamentous cervical injury can result in misalignment (subluxation), curve deformation, and cervical spine instability.
Cervical curve correction often consists of utilizing patient-specific weights in a standing or weight-bearing position. Under x-ray guidance, specific chest and/or head weights are used to determine the best method of cervical curve correction. Other therapeutic components of the curve correction program include specific chiropractic adjustments (Dynamic Orthoneurological Correction), a Denneroll (chiropractic neck wedge), specific exercises, and of course, proper ergonomics while working. Cervical curve correction therapies optimize curvature and positioning, thereby helping to stabilize the spine. Because there is a significant correlation between increasing forward head posture and increasing neck pain and disability, treatment is imperative.
Prolotherapy is a regenerative injection technique that stimulates repair of injured soft tissues, including cervical spine ligaments. Prolotherapy to the cervical spine involves injecting an irritating solution (often dextrose) at ligament and tendon attachment sites that creates a mild inflammatory response, initiating the body’s natural healing cascade targeted at poorly vascularized tissue.
Hear how our patients overcame their blurry vision symptoms!
We have extensive articles on this treatment:
Nystagmus – Oscillopsia caused by cervical spine instability and neck pain
Our published research
References
1 Hammoor BT, Cohen LL, Xiong GX, Lightsey HM, Lindsey M, Fogel HA, Tobert DG, Hershman SH. Laminectomy and fusion better maintains horizontal gaze than laminoplasty in cervical spondylotic myelopathy. North American Spine Society Journal (NASSJ). 2025 Mar 1;21:100575. [Google Scholar]