Dizziness and falls are common in older people, with 30% of people over 80 reporting they suffer from dizziness and 50% reporting falls. Both can cause great distress and reductions in quality of life, and falls cost the NHS about £2.3 billion per year. Both dizziness and falls are geriatric syndromes and linked to several risk factors, with visual impairment being one of them. This article describes the relationship between dizziness, falls and visual impairment (including a discussion of the importance of the vestibulo-ocular reflex) and then discusses possible optometric interventions that may help reduce dizziness and falls. The interventions include changing spectacles little if possible (‘if it ain’t broke, don’t fix it’); prescribing refractive correction conservatively, particularly for oblique astigmatism; avoiding high-addition multifocals; providing distance single-vision spectacles for active multifocal wearers; referring for cataract surgery or home safety modification when appropriate and providing appropriate advice and information.