True vertigo is predominantly associated with which ocular finding?

True vertigo is primarily characterized by a sensation of spinning or movement, which often results from inner ear or central nervous system disorders. The ocular finding that is predominantly associated with true vertigo is nystagmus.

Nystagmus is an involuntary oscillation of the eyes and is commonly observed in patients experiencing vestibular dysregulation. This eye movement can be horizontal, vertical, or rotary and is frequently triggered by changes in head position or other movements. In conditions causing true vertigo, nystagmus serves as an important clinical sign reflecting the vestibulo-ocular reflex and the brain's processing of balance and spatial orientation.

For instance, peripheral causes of vertigo, such as Benign Paroxysmal Positional Vertigo (BPPV) or vestibular neuronitis, often exhibit specific patterns of nystagmus, while central causes might produce different or more complex nystagmus patterns. Understanding nystagmus in this context helps clinicians ascertain the etiology of the vertigo and tailor appropriate management.

Other options like strabismus, gaze palsy, and internuclear ophthalmoplegia (INO) are associated with different neurological pathologies and do not typically indicate true vertigo. Thus, the presence