One of the most common complaints in ENT clinics is dizziness. Although most cases are caused by vestibular neuritis and benign paroxysmal positional vertigo (BPPV), a significant number of patients experience non-vestibular dizziness. One non-vestibular cause is postural orthostatic tachycardia syndrome (POTS), which presents with symptoms similar to vestibular migraine (VM) and persistent postural perceptual dizziness (PPPD). Dizziness from POTS is related to dysautonomia rather than the vestibular system. In otolaryngology, understanding the autonomic nature of non-vestibular dizziness is important for accurate diagnosis. This study aims to review the clinical characteristics and pathophysiology of POTS, vestibular migraine, and PPPD; examine historical, physical, and diagnostic findings that differentiate autonomic and vestibular causes of dizziness; and develop a more specific model for evaluating chronic dizziness in the ENT setting. Literature on dizziness, vestibular and autonomic pathophysiology, and the clinical presentation of POTS, VM, and PPPD is reviewed in this paper. The timing of symptoms, their triggers, and objective assessment are key differentiating factors for these disorders. Various diagnostic tools, including orthostatic vital signs, oculomotor assessment, gait and balance evaluation, vestibular function assessment, tilt table testing, and neuroimaging, are also reviewed. Clear distinctions among POTS, VM, and PPPD are made. The diagnostic criteria for POTS are orthostatic tachycardia and posture-dependent symptoms that improve when the patient is in a recumbent position, effectively ruling out vestibular involvement in these patients. Vestibular migraine presents with vertigo accompanied by migraine features such as photophobia, phonophobia, or headache, typically triggered by sensory or environmental factors rather than changes in posture. PPPD manifests as chronic non-spinning dizziness and imbalance lasting at least three months, exacerbated by motion, upright posture, and complex visual environments. Orthostatic vital signs and autonomic assessment should be included in the evaluation of patients presenting with dizziness to differentiate between these disorders. Both vestibular and autonomic dysfunction can lead to chronic dizziness. By incorporating autonomic assessments into vestibular evaluations, ENT physicians can apply a more precise diagnostic model for their patients. Identifying dysautonomia-related dizziness, including POTS, helps reduce the misdiagnosis of vestibular disorders. This approach enables physicians to provide more effective interventions for patients with complex dizziness.

Visual complaints are common after mild traumatic brain injury (mTBI), yet the scope, assessment approaches, mechanisms, and rehabilitation strategies reported in the literature remain heterogeneous. To synthesize evidence on post-concussive visual symptoms, diagnostic/assessment approaches, treatment/rehabilitation strategies, and putative mechanisms. Relevant studies published between 1997 and 2025 were identified and screened; 57 studies reporting visual outcomes following mild traumatic brain injury were included. The literature comprised cohort and cross-sectional studies, randomized and non-randomized intervention studies, case series and case reports, as well as selected guidelines and reviews. Studies were tagged to five domains (Symptoms; Diagnosis/Assessment; Treatment/Rehabilitation; Pathophysiology/Mechanisms; Epidemiology). We performed narrative synthesis with quantitative tabulation and co-occurrence mapping (symptom-test; symptom-treatment). Frequencies of symptom types, assessment modalities, intervention categories, mechanistic signals, and their co-occurrences. Publications spanned 1997-2025, with 56.1% appearing in 2021-2025. Symptoms were reported in 49 studies, dominated by oculomotor disturbances (46.9%) and photophobia (36.7%); binocular anomalies were frequent (diplopia 18.4%; convergence insufficiency 16.3%; accommodative insufficiency 14.3%). Among 21 assessment papers, clinical tests used to assess binocular-vision metrics predominated (accommodation 57.1%; vergence 38.1%; NPC 19.0%), with selective device-based testing (VEP 19.0%; eye-tracking 14.3%; OCT 9.5%). Twenty-one treatment studies most often described vision/orthoptic therapy (47.6%) and vestibular-oculomotor rehabilitation (42.9%); prisms (19.0%) and tinted lenses (14.3%) were used in targeted subgroups. Mechanistic reports (n = 29) emphasized oculomotor control abnormalities (79.3%), with smaller contributions from VOR and VEP findings; structural correlates (DTI/OCT) were less common. Co-occurrence analyses showed dense links between oculomotor symptoms and accommodation/vergence/NPC testing, and between photophobia and spectral filters. Post-concussive visual sequelae are clinically coherent and largely reflect neuro-oculomotor dysfunction with frequent binocular anomalies and photosensitivity. High-yield assessment centers on vergence, accommodation, and NPC, optionally augmented by screening tools and selective device-based measures. The most consistent therapeutic signals favor vision/orthoptic and vestibular-oculomotor rehabilitation, with prisms and tinted lenses for select indications. Standardized outcomes and well-powered comparative trials are needed to strengthen recommendations. This review integrates symptoms, objective testing approaches, and rehabilitation outcomes across the neuro-visual sequelae of mTBI and provides a structured clinical mapping of symptom-test and symptom-treatment linkages.

Chronic red eye is a prevalent presentation in both primary care and emergency settings. While most cases are self-limiting, recurrent or treatment-resistant episodes warrant systematic evaluation to exclude underlying chronic inflammatory conditions. We report the case of a 19-year-old female patient with a longstanding history of bilateral red eye associated with pain, photophobia, and epiphora, initially and repeatedly managed as infectious conjunctivitis in the emergency department (ED). Despite multiple antibiotic courses, symptoms persisted. Ophthalmologic evaluation ultimately revealed chronic anterior and posterior blepharitis with meibomian gland dysfunction, peripheral corneal infiltrates, and neovascularization (NV) - findings consistent with ocular rosacea. Notably, subtle cutaneous signs of rosacea were also identified on clinical examination, further supporting the diagnosis. Following targeted therapy with oral doxycycline 100 mg twice daily, topical corticosteroids (CSs), and ocular lubricants, the patient achieved significant clinical improvement. This case highlights the diagnostic pitfalls of recurrent red eye in primary care, the importance of recognizing chronic inflammatory ocular surface disease, and the value of timely ophthalmologic referral in preventing irreversible corneal complications.

Acute headache is a common clinical presentation with a broad differential diagnosis, ranging from benign to life-threatening conditions. Early recognition of atypical causes is essential, particularly when initial investigations are inconclusive. The etiology of acute headache can be broadly classified into primary and secondary causes. Primary headaches occur in the absence of identifiable structural pathology, whereas secondary headaches arise from an underlying organic cause. In this case presentation, a 65-year-old woman presented with a severe headache, which was triggered by an episode of sneezing. The pain was severe, rated 10 out of 10 in intensity, described as a constant dull ache that was felt all over the head but was more prominent in the occipital region, and it was accompanied by photophobia. The pain was not relieved by pain medications and was not associated with fever or trauma. No past history of migraine. On examination, she had no neck stiffness or abnormal neurology. Eye examination revealed bilateral redness and dilated and fixed pupils. Pain continued to be severe despite regular analgesia. A CT head revealed no space-occupying lesion or bleed. She was admitted for close observation and consideration of further investigations, including MRI, lumbar puncture, and inpatient neurology review. Unfortunately, before the MRI, the headache worsened, and the patient also complained of reduced vision in both eyes. An urgent ophthalmology review was requested, which revealed increased intraocular pressure (IOP) in both eyes (right eye 39 mmHg, left eye 40 mmHg, normal IOP: 10-21 mmHg). She was diagnosed with bilateral acute angle-closure glaucoma (AACG). She was given medical management as per the glaucoma protocol; however, as the headache worsened, medical management failed to reduce ocular pressure. She was taken for emergency anterior chamber (AC) paracentesis due to refractory IOP and peripheral iridotomy on the same day as definitive management. Over the next few days, her vision and headache started to improve. She was discharged with regular follow-up with the glaucoma clinic.