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See Sick Syndrome: Its Diagnosis and Treatment with Simple Home or Office Vision Therapy

Roderic Gillilan, OD

Bradley Coffey, OD, FAAO

Hannu Laukkanen, OD, MEd, FAAO

Nora M. Y. Chan, BS

Hong Nguyen, BS

Pacific University, College of Optometry

2043 College Way

Forest Grove, Oregon 97116

Manual for SEE Sick Syndrome

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This SPECIAL TWO CREDIT HOUR VIDEO-BASED course includes 3 parts.

The first part is a video of a classroom presentation by Dr. Bradley Coffey on the visual and vestibular interactions that contribute to motion sickness and related problems. Dr. Coffey discusses:



The second part is a video presentation by Dr. Roderic Gillilan who demonstrates his treatment regimen for a condition he terms "See Sick Syndrome." This presentation also includes a manual prepared by Dr. Gillilan that can be reproduced and used for treatment of See Sick Syndrome patients. Dr. Gillilan discusses and demonstrates:



The final part of the course is a CE credit examination that can be taken on this Web site.


The movies may be found at:


Overview of Motion Sickness and Gillilan See Sick Syndrome

Motion distress is a condition known by many names that include carsickness, airsickness, seasickness, mal de mere, space sickness (if the patient happens to be an astronaut), See Sick Syndrome (SSS), also known as Neuro-Ocular-Vestibular Dysfunction (NOVD).

Signs and symptoms are varied depending on the patient and provocative conditions but typically include gastrointestinal upset, sleepiness, headache, cold sweats, changes in vision or hearing, anxiety, vertigo/dizziness, and a feeling of being overwhelmed by sensory inputs.

Although, this condition is very common (it is often said that anyone will experience motion distress if sufficient provocation is provided), the exact etiology of distress is not fully understood.

Some theories, such as the one proposed by Gillilan, suggest that some forms of motion sickness involve a "super sensitive reaction" to visual and/or eye motion, which is often accompanied extreme photophobia.

Other theories involve a sensory mismatch in which the brain receives conflicting information from the visual, vestibular, and/or somatosensory systems. For example, when riding in an airplane or a boat, the inside of the cabin appears stable to the visual system, but the vestibular and somatosensory systems detect motion. A similar condition exists when riding in the back seat of a car when the passenger cannot see out.

In space, the opposite condition occurs. As he or she moves around the spacecraft, an astronaut's visual system detects movement, but, because there is insufficient gravity to create movement of the fluid in the inner ear, the vestibular system signals that the astronaut is not moving. The result can be debilitating motion sickness for a significant percentage of astronauts.

For many patients, motion distress also has a significant psychological component. Fear of motion distress is often enough to trigger gastrointestinal distress and feelings of vertigo/dizziness can follow. The more the patient experiences these feelings, the more the autonomic nervous system becomes involved and the worse he or she feels. In some cases, just thinking about provocative situations can trigger motion distress. It is sometimes possible to resolve or suppress the original cause of motion distress and still have a symptomatic patient because of a remaining psychological overlay. The opposite is also possible. The patient can be psychologically desensitized to the symptoms of motion distress and learn to disregard them even though they persist.

Treatment of motion distress is varied, and, to a great degree, depends on the professional background of the person providing the treatment. General practice physicians often prescribe sedating antihistamines such as diphenhydramaine to calm the vestibular system. Physical therapists, vestibular specialists, and functionally-oriented optometrists sometimes use therapy exercises during which patients adapt to or correct sensory mismatches, and psychologists can help patients learn to pay less attention to their symptoms. Other treatment approaches involve correcting visual system problems such as poor binocular vision or vertical imbalances. Still others involve the use of various medications such as scopolamine and alprazolam, and home remedies such as the spice ginger.

Clearly, motion distress, by whatever name it is known, is a major problem for many patients, and is amenable to many treatment approaches. Beyond this course, additional information on Motion Sickness is provided in another Pacific University On-Line CE course titled, "Etiology and Management of Motion Sickness: A Review." The On-Line course catalog is at

Occasionally patients will confuse dizziness or other problems caused by a pathological condition (e.g., hypertension or a brain lesion) with motion distress. For this reason, any treatment of motion distress should be preceded by a through evaluation to rule out pathology. See the Pacific University On-line Course titled, "Sensory Conflict And Other Causes Of Dizziness: Etiology, Differential Diagnosis, And Management." The On-Line course catalog is at


Disclaimer: "As with any therapy procedure, care must be taken to ensure that the patient does not have an acute disease that should be treated by direct intervention, e.g., medication or surgery. For this reason, all patients should be examined and given a clean bill of health by a competent health care provider prior to SSS/NOVD training. During training, some procedures might make the patient slightly dizzy and/or disoriented. Extreme care must be taken to protect the patient from falling. Patients should not drive a car or operate machinery while they are dizzy or disoriented. No guarantee or warrantee is made that this training will be helpful for all patients. Each health care provider using SSS/NOVD therapy must evaluate all patient variables and decide for him- or herself whether the therapy is appropriate for any given patient. The authors of this course assume no liability for the use or misuse of SSS/NOVD therapy."


Contact this author:
Roderic Gillilan, OD


Pacific University College of Optometry provides On-Line CE as a service to optometrists. The college does not endorse or recommend any products, equipment, or services that might be discussed in the courses. Courses are prepared by individuals believed to be experts in their areas of specialization who are compensated for their efforts. The College relies on their expertise to produce accurate and timely courses. Questions or concerns about courses should be directed to the individual authors and/or the Continuing Education Department at the College of Optometry at