
Ehlers-Danlos Syndrome (EDS) and Hypermobility Spectrum Disorder (HSD) are commonly known for their impact on joints, skin, and connective tissues. But one lesser-known, yet frequently reported symptom in EDS/HSD patients is binocular vision dysfunction. For many, vision problems can affect daily life just as much as the more visible symptoms of these connective tissue disorders. Understanding why people with EDS/HSD are prone to binocular vision issues is key to better management and support.
Understanding Binocular Vision Dysfunction
What is Binocular Vision Dysfunction?
Binocular Vision Dysfunction (BVD) occurs when the eyes struggle to work together to focus on a single point. This misalignment leads to issues with depth perception, coordination, and stability. BVD can manifest through various symptoms, including blurred or double vision, headaches, dizziness, and balance problems—many of which overlap with symptoms of Ehlers-Danlos Syndrome (EDS) and Hypermobility Spectrum Disorder (HSD). This overlap is significant, as vision-related issues often go unnoticed in EDS/HSD patients, complicating diagnosis and treatment.
Common Symptoms of BVD:
Visual Symptoms:
Blurred, shadowed, or double vision
Overlapping images or words appearing to move while reading
Skipping lines or losing your place when reading
Closing or covering one eye for clarity
Sensitivity to light and glare
Physical Symptoms:
Headaches and eye pain (especially with eye movement)
Neck, upper back, or shoulder pain
Fatigue or difficulty comprehending during reading
Poor depth perception
Balance and Coordination Issues:
Dizziness, lightheadedness, or a sensation of floating
Poor balance and a tendency to drift while walking
Clumsiness or lack of coordination
Emotional and Environmental Symptoms:
Anxiety in crowded or open spaces
Nausea and motion sickness
Feeling disoriented, especially while driving or stopped at a traffic light
A sensation of movement while stationary
If you experience any of these symptoms, you may have Vertical Heterophoria or another form of Binocular Vision Dysfunction.
How EDS/HSD Affects Vision
1. Connective Tissue Laxity and Eye Muscles
The collagen deficiency in EDS/HSD weakens not only joint and skin stability but also the connective tissues surrounding the eye muscles. When these tissues are overly lax, it affects the eye muscles’ ability to maintain proper alignment, leading to conditions like strabismus (misalignment of the eyes) or convergence insufficiency (difficulty focusing on nearby objects). This muscle instability can make focusing difficult, causing symptoms associated with BVD, like eye strain, headaches, and visual fatigue.
2. Neurological Impact on Vision
EDS/HSD is associated with various neurological symptoms due to its impact on the nervous system, and the eyes are no exception. Patients with EDS/HSD may experience issues with proprioception— the body's ability to sense its location in space—affecting eye coordination. This misalignment or delayed visual response can exacerbate symptoms like dizziness and vertigo, especially when shifting focus or moving quickly.
Overlap with ADHD Symptoms
For people with EDS/HSD, BVD symptoms like difficulty focusing, poor depth perception, and visual fatigue may resemble or intensify ADHD symptoms. This is particularly important as ADHD is more prevalent among EDS/HSD patients than in the general population, making it easy for BVD-related symptoms to be misattributed to ADHD. For instance, frequent eye strain, difficulty concentrating, or restlessness when reading or focusing on close tasks may be signs of BVD rather than solely ADHD.
This overlap suggests that those with both EDS/HSD and ADHD symptoms may benefit from a thorough vision assessment to rule out or confirm BVD as a contributing factor. Comprehensive care for individuals with these conditions often requires attention to visual health to ensure an accurate diagnosis and effective treatment plan.
Overlap with POTS
The symptoms of BVD often overlap with those of POTS and EDS, including:
Dizziness and balance problems
Headaches or migraines
Nausea
Difficulty concentrating or brain fog
Visual disturbances such as blurred or double vision
Given this overlap, it’s easy to see why BVD might be overlooked in patients already diagnosed with POTS or EDS. However, addressing BVD can be a crucial step in alleviating symptoms that persist despite treatment for POTS or EDS.
Differential Diagnosis
Since BVD can mimic the symptoms of other conditions, it’s common for this condition to be mistaken for something else. These conditions include:
ADHD
Dyslexia
Anxiety disorders
Myasthenia gravis (an autoimmune disorder affecting muscle movement)
Benign paroxysmal positional vertigo (a disorder which causes bouts of vertigo symptoms)
Other developmental or learning disorders
Treatment Options and Management Tips
Vision Therapy and Rehabilitation
Vision therapy, conducted by an optometrist specializing in binocular vision, can improve symptoms. Therapy often includes eye exercises to strengthen the muscles and improve alignment, and may also involve using specialized lenses or prisms to help correct eye positioning. Although it may not entirely eliminate symptoms, many patients report significant improvements with regular therapy.
Prism Glasses
Prism lenses can be used to align the visual field for patients experiencing double vision or convergence issues. These lenses help redirect light into the eyes at an angle that improves alignment, offering relief for symptoms like dizziness and headaches.
Regular Eye Exams with a Specialist
Patients with EDS/HSD should seek eye exams from professionals experienced in binocular vision issues and connective tissue disorders. Regular check-ups help monitor changes in vision and adjust treatments as needed.
Posture and Lighting Adjustments
Adjusting your reading or work environment—such as using adequate lighting, reducing screen glare, and ensuring proper posture—can reduce eye strain and visual discomfort. Regular breaks and “eye-rest” exercises (like the 20-20-20 rule: looking at something 20 feet away for 20 seconds every 20 minutes) can be helpful.
Mindful Movement and Stability Exercises
For those experiencing vertigo or balance issues related to BVD, low-impact exercises that improve balance and stability, such as yoga or tai chi, may support coordination between vision and movement. These can also help strengthen proprioception, reducing dizziness over time.
Moving Forward: Addressing Binocular Vision Issues in EDS/HSD Care
Acknowledging binocular vision dysfunction as a component of EDS/HSD care is vital to improving quality of life for patients. Proper diagnosis and management can make a meaningful difference, particularly when addressed as part of an integrated care approach. Increased awareness of BVD among healthcare professionals can ensure that more EDS/HSD patients receive appropriate, holistic treatment, addressing both visible and invisible symptoms of these conditions.
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