Purpose of review: The influence of anxiety on ocular motor control and gaze has received less research attention than its effects on postural control and locomotion. This review summarizes research on trait anxiety, state anxiety, anxiety disorders, ocular motor reflexes, and gaze. It applies these findings to clinical problems of visually induced unsteadiness and dizziness (VUD, also known as visual vertigo), fear of falling (FoF), and chronic subjective dizziness (CSD).
Recent findings: Humans are inherently more sensitive to vertical heights than horizontal distances. Vertical height intolerance is reported by one-quarter to one-third of the general population. Humans also possess a gaze bias toward potentially threatening stimuli in the visual field, more prominent in individuals with higher versus lower trait anxiety and increased by state anxiety. This bias may drive hypervigilance-avoidance gaze patterns in patients with social anxiety disorder and specific phobias. Trait and state anxiety also appear to adversely affect gaze control, reducing gaze stability on visual targets. This may be one mechanism underlying persistent VUD and visual symptoms of CSD. Anxiety-related gaze diversion may increase gait instability in patients with FoF.
Summary: Anxiety affects ocular motor reflexes and gaze control in ways that may contribute to clinically significant visual and visual-vestibular syndromes.