The Halpern syndrome of monocular visual vertigo: A rare cause of monocular eye closure

Background: Halpern syndrome is a vestibular disorder characterized by vertigo, a tendency to tilt to one side, and spontaneous closure of the ipsilateral eye. Symptoms are exacerbated during monocular viewing with the ipsilateral eye and alleviated during monocular viewing with the contralateral eye. It has long been attributed to a mismatch between visual and vestibular input. Methods: Reexamination of Halpern syndrome in light of new concepts of visuo-vestibular disease. Results: The visually dependent postural disequilibrium in Halpern syndrome recapitulates the dorsal light reflex in fish, in which unequal luminance input to the two eyes evokes a tilt of the body toward the brighter side. Conclusion: Patients with Halpern syndrome close one eye to restore vertical postural orientation. Halpern syndrome may result from reactivation the dorsal light reflex in the setting of central vestibular disease.