Click here to access the handout for full educational breakdown in the attached

Ever notice how your patients with autonomic dysfunction seem to have “tunnel vision” — not ophthalmologically, but functionally?

There’s a reason.

I’m in the middle of a series on extraocular muscles, cranial nerves, and VOR connections. But I wanted to pause and share a bonus piece: the intricate relationship between our visual system and autonomic regulation.

Central vision (Parvocellular pathway) has strong sympathetic connections. Peripheral vision (Magnocellular pathway) links to parasympathetic function and subcortical emotional centers.

Under acute stress, this system works beautifully — central vision pauses to let peripheral vision orient us to potential threats.

But under chronic stress — persistent dizziness, pain, fear of falling — patients collapse their central system AND minimize peripheral input. Their visual field becomes “small and flat.”

Here’s the challenge in vestibular rehab: we focus on sensory facilitation when the real issue may be a lack of inhibition.

We don’t learn in fight, flight, or freeze — we survive.

If neuroplasticity is our goal, we must down-regulate before we can up-train. Deep breathing and strategic peripheral eye movements aren’t nice additions — they’re foundational.

By Bridgett Wallace, PT, DPT ~ 360 Neuro Health Co-Founder & Director of Clinical Education