Search Results (674)

Background/Objectives: We aimed to describe clinical phenotypes, imaging distribution, treatment time window, and short-term outcomes of ophthalmic–cerebral artery embolic stroke caused by cosmetic facial injections or fillers in a tertiary neurology-referred cohort. Methods: This single-center retrospective observational case series included 33 consecutive eligible patients with ophthalmic artery embolism complicated by cerebral infarction or optic nerve ischemia after cosmetic facial injections. All 33 patients had cerebral infarction. Demographic, clinical, imaging, treatment-timing, and discharge-outcome data were extracted from medical records and analyzed descriptively. Results: Mean age was 31.1 ± 7.5 years (median 30.0, IQR 25.0–37.0); 29 (87.9%) were female. The injected materials were as follows: hyaluronic acid (24, 72.7%), autologous fat (8, 24.2%), and unknown (1, 3.0%). Anterior circulation involvement occurred in 32 patients (97.0%), posterior in 16 (48.5%) (an exploratory observation of uncertain mechanism; 15/16 co-occurred with anterior involvement), both in 15 (45.5%), multifocal/multi-territorial infarction in 24 (72.7%), and hemorrhagic transformation in six (18.2%). Optic nerve ischemia co-occurred in 25/33 patients (75.8%); no patient had isolated optic nerve ischemia without cerebral infarction. Median time from onset to intervention was 25.4 h (IQR 9.0–34.5); only two of 28 (7.1%) received intervention within 6 h. Within our cohort, earlier intervention was not associated with visual improvement (≤24 h 3/10 vs. >24 h 2/14; Fisher’s p = 0.61). At discharge, as a within-patient change between admission and discharge (not a controlled treatment-effect estimate), ocular motility abnormalities improved (17/26, 65.4%, p < 0.001), skin abnormalities improved (17/27, 63.0%, p < 0.001), and severe visual impairment improved (6/29, 20.7%, p = 0.031). Conclusions: Cosmetic facial injection/filler-related stroke is a specific type of iatrogenic embolic stroke caused by the dissemination of exogenous materials through facial–orbital–intracranial anastomotic pathways. Because the cohort was ascertained through a tertiary neurology department, the phenotype reflects the severe, brain-involved end of the spectrum and the distribution estimates are not generalizable to the full spectrum of filler-related vascular events. For patients presenting with acute blindness accompanied by skin ischemia, ocular muscle abnormalities, or neurological symptoms following cosmetic injections, early referral to both the stroke green channel and emergency ophthalmology for multidisciplinary evaluation is recommended, primarily to limit cutaneous necrosis, support extraocular muscle recovery, and monitor and control infarct progression and hemorrhagic transformation rather than to restore vision. Full article

Dry Eye Disease (DED) is a multifactorial condition increasingly affecting young populations, including medical students, due to intensive screen use, prolonged near work, and demanding academic environments. This study aimed to estimate the prevalence of DED-related outcomes among medical students and to examine how estimates vary according to diagnostic methods, methodological characteristics, and publication period. A systematic review with meta-analysis was conducted. PubMed, Scopus, Web of Science (including SciELO), and EMBASE were searched from January 2000 to March 2026. A random-effects model was applied, and subgroup, sensitivity, and exploratory meta-regression analyses were performed. Twenty-seven studies were included, comprising 12,501 participants. The pooled prevalence of DED-related outcomes was 47.4% (95% CI: 38.4–56.4%); however, between-study heterogeneity was extreme (I² = 99%). Therefore, this estimate should be interpreted as an approximate summary of a highly heterogeneous evidence base rather than as a definitive global epidemiological value. Prevalence estimates varied according to diagnostic approach, particularly between self-report, symptom questionnaires, and clinical tests. Exploratory meta-regression suggested a positive association with publication year, but these analyses did not meaningfully resolve heterogeneity and should not be interpreted as causal evidence of a temporal increase. Standardized diagnostic approaches combining symptoms and ocular surface signs are needed to improve comparability across studies and inform preventive visual-health strategies in medical education. Full article

Background: As many as two-thirds of acutely dizzy patients presenting to the emergency department report intermittent symptoms only, consistent with a transient acute vestibular syndrome (single episode lasting < 24 h) or an episodic vestibular syndrome (recurrent episodes, each lasting < 24 h). A broad differential diagnosis, presentation outside the episode(s), and difficulties in describing the symptoms make the diagnostic workup of transient vestibular symptoms (TVS) challenging. Methods: This critical review provides an overview on the management of TVS, focusing on structured history-taking and bedside testing, but also reviewing the role of neuroimaging and eye movement recordings. Results: Asking about timing and triggers helps clarify the temporal evolution of symptoms (transient vs. persistent) and the circumstances of occurrence (spontaneous vs. triggered). Such structured history-taking narrows down the differential diagnosis and ensures appropriate bedside tests. On clinical examination, identifying focal neurologic signs, (subtle) ocular motor findings, and gait imbalance is essential. While positional testing should be applied in all patients with TVS, HINTS+ has not been validated in those patients without nystagmus or with transient (already resolved) symptoms. For neuroimaging, MRI with diffusion-weighted imaging is preferred, but early false-negative findings in up to 20% (to even 50% for small brainstem strokes) of cases must be considered. Quantitative eye movement recordings may be especially valuable in rural areas, supporting telemedicine consults. Conclusions: Special emphasis should be put on distinguishing vertebrobasilar transient ischemic attack from vestibular migraine and cardiac arrhythmia. In the case of triggered TVS, immediate and sustained response to liberation maneuvers strongly supports benign paroxysmal positional vertigo over vestibular migraine or structural central positional nystagmus. Treatment strategies in TVS strongly depend on the underlying cause, ranging from hyperacute stroke treatment to migraine prophylaxis to liberation maneuvers. Full article

Tear film instability and dry eye disease (DED) are among the most common postoperative complaints after anterior segment surgery. Cataract surgery, corneal refractive procedures, keratoplasty, glaucoma filtration surgery, and pterygium excision can all disrupt ocular surface homeostasis through mechanisms that include corneal denervation, inflammation, goblet cell loss, and meibomian gland dysfunction. The severity and duration of postoperative dry eye vary substantially according to the surgical procedure performed. This review summarises current evidence on the pathophysiology, clinical manifestations, objective tear film changes, and recovery patterns following major anterior segment interventions. Particular emphasis is placed on standardised, non-invasive assessment methods, including tear breakup time, tear meniscus height, meibography, and validated symptom questionnaires. Procedure-specific recovery trajectories are compared to distinguish transient postoperative tear film instability from persistent chronic dry eye disease. Evidence-based management strategies, including preoperative risk stratification, intraoperative optimisation, and multimodal postoperative therapy, are also reviewed. Understanding these distinct recovery patterns may improve surgical planning, patient counselling, early intervention, visual outcomes, and patient satisfaction. Full article

Background and Clinical Significance: Tumors of the lacrimal drainage system are rare but clinically important diagnostic pitfalls because they may mimic benign lacrimal drainage obstruction, chronic dacryocystitis, or sinonasal disease. Pleomorphic adenoma (PA) in this region is exceptionally rare, and delayed recognition may allow progressive extension into adjacent structures. Case Presentation: A 51-year-old woman presented with left nasal obstruction 16 years after external dacryocystorhinostomy for presumed lacrimal drainage obstruction. Examination showed a firm left lacrimal sac mass, proptosis, mild ocular motility limitation, and an intranasal mass. Computed tomography and magnetic resonance imaging showed a large lesion centered in the lacrimal sac region and extending into the nasolacrimal duct, nasal cavity, and maxillary sinus, with orbital displacement. Preoperative biopsy showed epithelial neoplastic tissue without definitive malignant features, but low-grade epithelial malignancy could not be excluded. Complete en bloc excision and medial/inferior orbital wall reconstruction with an autologous calvarial outer table bone graft were performed. The tumor measured 55 × 35 × 25 mm. Final histopathology confirmed PA without malignant transformation. At 2 years postoperatively, there was no recurrence, and proptosis and ocular motility limitation had improved. Conclusions: This case illustrates two diagnostic pitfalls: an underlying tumor may masquerade as lacrimal drainage obstruction, whereas a large benign PA may clinically and radiologically mimic malignancy. Long-standing or atypical unilateral lacrimal symptoms should prompt consideration of tumors and selected use of imaging and tissue diagnosis before lacrimal drainage surgery. Full article

Background and Clinical Significanc: Neuropathic corneal pain is a debilitating condition characterized by ocular pain disproportionate to clinical signs, often resulting from peripheral and central sensitization of the corneal somatosensory pathway. Emerging evidence suggests that chronic involuntary muscle contraction in blepharospasm may lead to irritation of trigeminal afferents and corneal neurogenic inflammation, potentially predisposing patients to neuropathic corneal pain. Given its debilitating nature, early recognition can prevent the progression of neuropathic sequelae. This study examines the potential role of blepharospasm as a predisposing factor contributing to neuropathic corneal pain. Case Presentation: This retrospective case series describes three cases (median age: 50 years) of neuropathic corneal pain in association with blepharospasm and their clinical course following multimodal treatment over a median follow-up period of one year. Ocular surface was evaluated using slit-lamp biomicroscopy, while corneal nerve structure and morphology were assessed with in vivo confocal microscopy. All the three subjects presented with minimal ocular surface staining but disproportionate ocular pain characterized by burning sensation and photophobia. Proparacaine challenge testing was performed to determine the subtype of neuropathic corneal pain. Pain symptoms and quality of life were evaluated using the Ocular Pain Assessment Survey and Ocular Surface Disease Index questionnaires. In vivo confocal microscopy demonstrated characteristic corneal nerve abnormalities including reduced corneal nerve density, increased nerve tortuosity, and the presence of microneuromas. Treatment included oral Pregabalin or Gabapentin, topical lubricants, Cyclosporine 0.05% (1 case), and 20% autologous serum eye drops (1 case). Two of the three cases received four to five injections of botulinum toxin for blepharospasm, whereas one had undergone a single injection prior to review. All patients also received weekly periorbital quantum molecular resonance electrotherapy for two months. Improvements were observed across multiple domains of the Ocular Pain Assessment Survey and Ocular Surface Disease Index evaluation, including ocular pain, photophobia, non-ocular pain, and quality-of-life measures following multimodal treatment. The co-existence of blepharospasm and neuropathic corneal pain observed in our cases supports a possible association between chronic periocular muscle hyperactivity and corneal nociceptor sensitization. Proposed mechanisms include chronic trigeminal nerve irritation, neurogenic inflammation, and sensitization mediated by pro-inflammatory neuropeptides. Multimodal treatment targeting both motor hyperactivity and neuropathic pain pathways appeared to provide symptomatic relief, including the use of quantum molecular resonance electrotherapy, which might modulate pain pathways, block nociceptor neurotransmission, and accelerate corneal nerve regeneration. Given the complexity of the neural pathways responsible for ocular discomfort, further studies are required to elucidate the relationship between neuropathic corneal pain and blepharospasm in larger cohorts, as well as refine existing therapeutic approaches, including evaluating the therapeutic role of electrotherapy. Conclusions: Blepharospasm may represent a potential predisposing factor of neuropathic corneal pain. Early recognition and concurrent treatment of blepharospasm and neuropathic corneal pain can effectively relieve symptoms and improve quality of life. Adopting a multimodal treatment approach is therefore recommended. Full article

Objective: To report a rare case of bilateral iris metastasis from small cell lung carcinoma (SCLC) and systematically review the literature on SCLC-associated iris metastases, with emphasis on clinical presentation, management, and outcomes. Materials and Methods: A systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, ScienceDirect, Scopus, and Web of Science were comprehensively searched on 10 July 2025. Eligible studies included English-language reports of iris metastasis originating from SCLC in human subjects. Case report: A 58-year-old woman with previously treated SCLC developed bilateral iris metastases one year after complete remission of the primary tumor. Ophthalmic examination revealed whitish-gray, vascularized iris masses with iridocorneal angle involvement, associated with secondary angle-closure glaucoma and markedly elevated intraocular pressure (48 mm Hg) in the left eye. Cyclocryotherapy, preceded by systemic and topical antiglaucoma therapy, resulted in pain relief and a reduction in intraocular pressure; the patient died four months later due to pneumonia. Results (Systematic Review): Seventeen studies comprising 17 patients were included; the median age was 60 years, and 64.7% were male. The median interval from SCLC diagnosis to ocular presentation was 4 months, although iris metastasis was occasionally the initial or concurrent manifestation of disease. The most common presenting features were visual impairment (58.8%), ocular pain (41.2%), and elevated intraocular pressure (41.2%), while iris neovascularization (35.3%) and synechiae (29.4%) were also frequent. Bilateral involvement was reported in only one previous case. Treatment approaches were heterogeneous and included antiglaucoma therapy, systemic chemotherapy, local radiotherapy, anti-VEGF therapy, and enucleation. Among patients with available follow-up (n = 12), 58.3% died within a median follow-up of 7.5 months. Conclusions: Bilateral iris metastasis from SCLC is rare and may occur as a manifestation of recurrent disease after remission. It is an aggressive condition characterized by nonspecific ocular symptoms, variable management, and poor survival, underscoring the importance of early recognition and the need for evidence-based diagnostic and therapeutic strategies. Full article

Background: Dry Eye Disease (DED) is a multifactorial ocular surface disorder characterized by tear film instability and inflammation. Cyclosporine A, an immunomodulator, and Diquafosol sodium, a mucin secretagogue, represent two distinct therapeutic pathways. However, current evidence directly comparing their clinical efficacy is inconsistent. This meta-analysis aimed to compare treatment outcomes and efficacy between 0.05% Cyclosporine A and 3% Diquafosol sodium in patients with moderate-to-severe DED. Methods: In January 2026, we conducted a systematic search of PubMed, Scopus, Web of Science, and the Cochrane Library for randomized controlled trials directly comparing 0.05% Cyclosporine A to 3% Diquafosol sodium in adult patients with moderate-to-severe DED. For the meta-analysis, we used R 4.5.0 with R Studio 2024.12.1+563. Results: We included six RCTs with a total of 859 patients. No significant differences were found between Cyclosporine A and Diquafosol sodium in Tear Break-Up Time (TBUT) at 4, 8, or 12 weeks. Cyclosporine A showed a suggestive greater improvement in Schirmer test scores at 4 weeks (SMD = 0.35, 95% CI 0.07 to 0.63). A modest benefit in symptom scores favoring Diquafosol sodium was observed at 12 weeks (SMD = 0.23, 95% CI 0.06 to 0.41). Subgroup analysis suggested this symptomatic benefit may be more pronounced in patients with severe disease, although subgroup interaction tests were not statistically significant. There were no significant differences in corneal or conjunctival staining at any time point. The risk of adverse events did not differ significantly between treatments. Conclusions: Early improvement in tear production showed a potential benefit for Cyclosporine A, while longer-term symptomatic relief showed a potential benefit for Diquafosol sodium, with suggestive evidence in severe disease. However, these findings should be interpreted cautiously, given the methodological limitations and inconclusive TSA evidence for several outcomes. Future large-scale, standardized trials with extended follow-up are warranted to confirm these findings. Full article

Pesticides are commonly used in agriculture to ensure disease-free products; however, comprehensive evidence of their mucocutaneous effects among Asian agricultural workers is limited. This scoping review aimed to map the prevalence, clinical characteristics, and contributing factors of pesticide-related mucocutaneous conditions among agricultural workers in Asia. The study was conducted in PubMed, Scopus, and the Directory of Open Access Journals to identify studies published between 2005 and January 2025. Observational and cross-sectional studies involving agricultural workers in Asia and examining pesticide exposure with associated mucocutaneous effects were included. Data were charted using a standardized form, including study details, participant demographics, prevalence of mucocutaneous symptoms, types of pesticides used, and exposure-related outcomes. A total of ten studies were included in the study. Skin-related symptoms ranged from 4.8% to 37.5%, while ocular symptoms ranged from 6.0% to 41.2%. Allergic contact dermatitis was reported in 26.1% of workers, and acute dermatitis accounted for 24.0% to 54.0% of pesticide-related dermatitis cases. Organophosphate insecticides, bipyridylium herbicides, and fungicides were commonly reported in relation to these effects. Limited personal protective equipment use and unsafe practices may have increased exposure risk. This review highlights the need for standardized exposure assessment, improved protective measures, and stronger occupational safety interventions. Full article

Oculomotor dysfunction is an eye movement disorder frequently experienced in patients with Parkinson’s disease. Many patients tend to experience visual symptoms, and this can exacerbate cognitive symptoms when visual tasks become more demanding. The purpose of this review is to characterize oculomotor dysfunction in patients with Parkinson’s disease based on the distinct types of ocular motor deficits and their corresponding impact on the patient’s symptoms, visual perception, activities of daily living, and quality-of-life. A systematic literature search was conducted to identify relevant articles. The results from the sensorimotor framework analysis are categorized in five domains: visual-sensory, visual-motor, visual-perceptual, cognitive processing, and psychosocial challenges. The findings suggest that clinical evaluation and neurorehabilitation should move beyond speed-dependent metrics, but focus on specific non-speed-dependent ocular motor deficits. By fostering interdisciplinary collaboration, healthcare professionals can take proactive steps to address the vision-related challenges faced by patients with Parkinson’s disease. Full article

Background: Chronic epiphora is a common ophthalmic complaint with multifactorial etiology, including both structural obstruction of the nasolacrimal drainage system (NLDS) and functional or ocular surface–related causes. Accurate differentiation between these conditions is essential for appropriate management, yet conventional diagnostic methods provide limited anatomical detail. The complementary role of advanced imaging in routine clinical decision-making remains incompletely defined. Methods: In this retrospective observational study, 127 patients with chronic epiphora who underwent CT-DCG as part of routine clinical care were analyzed. CT-DCG was performed in patients with suspected NLDS involvement. Clinical, functional, and imaging data were analyzed, and multivariable logistic regression was used to identify factors associated with surgical management. Results: Distal NLDS involvement was the most common CT-DCG finding. Purulent discharge and longer symptom duration were associated with surgical management. Duration of symptoms remained independently associated with surgical management (OR 1.04 per month, 95% CI 1.02–1.06, p < 0.001), while purulent discharge was also strongly associated, although the confidence interval was wide. Functional parameters, including fluorescein dye disappearance test and dry eye syndrome, were not independently associated. The model demonstrated good discrimination (AUC 0.89). Conclusions: CT-DCG provides detailed anatomical assessment of lacrimal drainage abnormalities in patients with chronic epiphora and may complement standard clinical evaluation in selected cases with suspected structural pathology. However, CT-DCG findings were analyzed primarily descriptively because several imaging subgroups were small. Clinical features such as prolonged symptom duration and purulent discharge were associated with surgical management, whereas functional tests alone showed limited independent association. Full article

Motorist’s disorientation syndrome (MDS) is seen in 1 to 5% of patients in a tertiary neurotology clinic and remains an underdiagnosed pathology. It was first described in 1985 by Page & Gresty, using the term “visual vertigo”. Patients described sensations of veering or turning over while driving an automobile when visual input was restricted. This was exacerbated at high speeds, on winding roads, going down hills, or when overtaken by a vehicle. All patients in this initial study had peripheral or central neurotological abnormalities and showed exaggerated responses during optokinetic stimulation. Some sufferers considered giving up driving. The first aims of this narrative review were to delineate the symptoms of MDS as detailed in the literature, to outline precipitating situations and to discuss associated pathologies such as anxiety. The second aim was to differentiate MDS from similar syndromes, such as persistent postural-perceptual dizziness (PPPD) and motion sickness (MS). In addition, we looked at the role of vestibular assessments and discussed the involvement of the otolith organs and semicircular canals. In this review, eight publications were analyzed. MDS is related to a visual-vestibular or a visio-visual conflict and occurs in drivers (both males and females). It is associated with anxiety in 17–39% of cases. Mild vestibular-test abnormalities or exaggerated response to opto-kinetic stimulations are seen in 60–100% of cases. Between 50 and 62% of patients have a migraine history. Convergence and strabismic problems are also often seen. Symptoms usually settle after 6 ± 4 years but can persist for longer in females. MDS is multifactorial, and similar to certain forms of PPPD but different than MS. Its pathophysiology is still in question, and we support the role of the velocity storage integrator as a recent hypothesis. Treatment includes vestibular rehabilitation, virtual reality, cognitive behavioral therapies and orthoptic sessions, and the results are promising. The authors also strongly feel that future research on clarifying MDS pathology should study a wider scope of vestibular assessments to evaluate semicircular canal/otolithic function, as well as the vestibulo-ocular reflex, analyze optokinetic nystagmus time constant, and perform a systematic orthoptic examination. Full article

Background: Paranasal sinuses and mastoid air cells have been attributed to multiple functions—such as voice resonance, cranial lightening, and pressure regulation—yet their potential role in local thermal homeostasis remains underappreciated. The thermoregulatory hypothesis, first proposed in the mid-twentieth century, was largely abandoned after the mid-century, when anthropological findings of climate-correlated variation seemed contradictory. Hypothesis: We propose that pneumatized skull regions form a three-component craniofacial biothermal system that maintains thermal stability in the ocular vitreous and vestibular endolymph, two avascular, temperature-sensitive structures that lack intrinsic thermoregulatory capacity. This represents a novel integration that explicitly links paranasal and mastoid pneumatization into a coordinated system that protects sensory organs, distinct from previous brain-cooling hypotheses. Mechanism: The system comprises: (1) passive thermal insulation via air spaces, providing ~15-fold greater thermal resistance than bone; (2) active cold protection via mucosal heat delivery (estimated 2–5 W capacity); and (3) active heat dissipation via evaporative cooling (estimated 0.3–0.5 W capacity). This architecture provides asymmetric protection, with cold buffering exceeding heat dissipation by approximately 5- to 15-fold, consistent with thermodynamic constraints and putative evolutionary priorities. Evidence: Preliminary observations consistent with this hypothesis include the anatomical proximity of pneumatized regions to the vitreous and labyrinth, intranasal selective brain cooling studies, and clinical observations after mastoidectomy showing preserved pressure buffering but reduced vestibular thermal insulation under extreme stimulation. Climate-correlated pneumatization patterns are consistent with bidirectional thermal adaptation. Implications: We present five falsifiable predictions that can be tested with thermographic imaging, pharmacological manipulation, and computational modeling. Validation could inform surgical planning, explain postoperative thermal-sensitivity symptoms, and provide evolutionary insights into craniofacial adaptation. Full article

Background/Objectives: Rhegmatogenous retinal detachment (RRD) is a surgical emergency that causes vision loss if not properly treated. Pars plana vitrectomy (PPV) is the preferred procedure for most complex RRD cases, with a high success rate. This study aimed to evaluate the significance of predictive factors and their impact on postoperative best corrected visual acuity (BCVA) in patients undergoing PPV for RRD. Methods: In this retrospective study, 136 eyes from 135 patients who underwent PPV for RRD were examined. A robust fitting algorithm for linear models was used to assess the influence of preoperative patient-related factors on the functional outcomes of PPV for RRD. Results: Various factors were analyzed, ranging from demographic parameters, such as gender and residency, to more complex ocular findings, including BCVA, duration of symptoms, description of the RRD, retinal tears, macular status, presence of proliferative vitreoretinopathy (PVR), epiretinal membrane, or macular hole. Conclusions: Duration of symptoms, phacoemulsification during follow-up, and preoperative BCVA showed a statistically significant correlation with postoperative BCVA. Lens status, macular status, extent of retinal detachment, number of tears, and PVR did not influence the postoperative outcome. Full article

Background/Objectives: Pregnancy involves significant hormonal, cardiovascular, and physiological shifts that may potentially affect the vestibular system. The utricle and saccule, the two primary otolith organs, are responsible for detecting linear acceleration and maintaining equilibrium. This study aims to objectively evaluate the functional status of these organs throughout the three trimesters of pregnancy using Vestibular Evoked Myogenic Potentials (VEMPs). Methods: A prospective cross-sectional study was conducted with 64 healthy primigravida women (mean age 29.4 ± 2.3 years). Cervical VEMP (cVEMP) and ocular VEMP (oVEMP) tests were performed at three distinct time points: the first (8–9 weeks), second (20–21 weeks), and third (33–34 weeks) trimesters. Latencies (p13 and n23 for cVEMP; n10 and p15 for oVEMP) and peak-to-peak amplitudes were recorded and statistically compared across trimesters. Results: No statistically significant differences were found in cVEMP p13 and n23 latencies or amplitudes across the three trimesters (p > 0.05). Similarly, oVEMP p15 latencies and amplitudes remained stable throughout the pregnancy (p = 0.43 and p = 0.95, respectively). While a slight numerical increase in certain latencies was observed in the third trimester, and the oVEMP n10 latency was found to be consistently prolonged compared to non-pregnant norms, these values remained stable between trimesters. The inter-aural asymmetry showed no significant deviations, indicating a balanced vestibular adaptation. Conclusions: The functional integrity of the saccule and utricle is preserved during a healthy pregnancy. Despite the dramatic increase in gestational hormones such as estrogen and progesterone, the otolith-dependent reflex pathways (vestibulocollic and vestibulo-ocular) remain resilient. These results provide a clinical baseline for evaluating vestibular symptoms in pregnant populations, suggesting that significant VEMP abnormalities should prompt investigation into underlying vestibular pathologies rather than being attributed to normal pregnancy changes. Full article