Objective To investigate the clinical value of video head impulse test (vHIT) in evaluating vestibular ocular reflex (VOR) in patients with peripheral vertigo. Methods Fifty-two patients with benign paroxysmal positional vertigo (BPPV) and 57 with vestibular neuritis (VN) admitted to our hospital from April 2019 to Oct 2020 were selected as the research objects, and 30 healthy ones as the control. The VOR gain values of a pair of horizontal semicircular canal planes, two pairs of vertical semicircular tube planes and three corresponding VOR gain asymmetry values were measured by vHIT, and the information of eye catching saccade was recorded. The abnormal rate of vHIT, the positive rate of gain asymmetry ratio and the positive rate of compensatory saccade were calculated. The sensitivity and specificity of vHIT in the diagnosis of VN were analyzed by receiver operating characteristic curve (ROC). Results Compared with the control group and BPPV group, the VOR gain of VN group decreased, and the corresponding asymmetry increased. There were no statistically significant differences in the gain value and gain asymmetry value between the BPPV group and the control group (P>0.05). The vHIT abnormal rate, gain value asymmetry ratio positive rate and compensatory saccade positive rate of the VN group were higher than those of BPPV group. The sensitivity, specificity, positive predictive value and negative predictive value of vHIT for VN diagnosis were 85.96%, 93.33%, 96.08% and 77.78% respectively. Conclusion vHIT can evaluate the vestibular function of patients with peripheral vertigo through VOR gain value, gain asymmetry value, abnormal vHIT ratio, positive rate of gain asymmetry ratio and positive rate of compensatory saccade, which has good clinical application value.