Vision Problems After a Concussion? What You Need to Know

So, last year I got a concussion. I was snowboarding in Canada with some friends and the next thing I remember, I was in the hospital getting a CT scan. Now, thankfully, all I suffered was some temporary memory loss, some whiplash, and a sprained shoulder with some heavy bruising on like my side and ribs. And now I'm doing great and I'm fully recovered. But, I wanted to use this as an opportunity to raise awareness about common eye and vision issues that can often occur after a concussion, also known as a mild traumatic brain injury. We'll review what type of symptoms can often appear and what they look like, and of course, what can be done about it. That way, hopefully, if you or a loved one ever get an injury or have symptoms like this, then you'll know not only more of what's going on, but how to seek appropriate care. Okay, so when

somebody has a concussion, whether that be from playing sports, a bad fall, or a motor vehicle accident, they can experience a whole mixed bag of symptoms. Things like headache, nausea, dizziness, also cognitive impairments like memory loss, brain fog, and delayed processing speed and reaction times, as well as vestibular issues that can often lead to vertigo or balance issues. And a lot of people don't realize how common the visual system is affected after a brain injury. In fact, about 65 to 80% of TBI cases have some form of visual dysfunction in the acute phase, which is the first four weeks after an injury. This is because every lobe of our brain is involved in processing what we see and how we move our eyes to maintain and change our visual focus. Now, visual symptoms after a brain injury include that of blurred or double vision, eye fatigue, light sensitivity, also difficulties focusing or maintaining focus, also challenges with reading because words often appear to move on the page or you may lose your place easily while reading. Tracking moving objects with your eyes can be a challenge and just the general difficulties while maintaining attention during a visual task. Interestingly, dry eyes and eye pain are also common after a concussion. Okay, now what can be

really tricky is that a lot of people experience these visual symptoms, but they go in to see their eye doctor and they look at their eyes and everything looks perfect. In fact, they still may be seeing 20/20 and the doctor says everything's fine. But, that's super frustrating for somebody who's having these visual symptoms and looking for answers. So, then the big question is where are these visual symptoms coming from? Well, it turns out they're mostly coming from eye movements or how the brain controls the eyes. The three most common eye movement issues diagnosed after an injury include one, accommodative insufficiency, two, which is convergence insufficiency, and three, saccadic dysfunction. Accommodation is the ability of the ciliary muscle to flex the lens inside of the eye to focus on what you want to see and it's neurologically controlled. Accommodative

insufficiency is where the communication between the brain and that ciliary body muscle inside the eye stops working the way it should. This causes people to have intermittent blurry vision and difficulty clearing their vision when looking at near such as reading a book or looking at their phone. Or, it may be a challenge to see clearly or comfortably when shifting your vision from far away to up close such as taking notes in a classroom. And for some cases, this can result in a deep feeling of eye pain or eye strain when doing a visual task for a long period of time. Now, convergence is the ability to cross one eyes, which we all need to do to maintain focus at near, such as looking at our phones. And convergence insufficiency is the inability or difficulty to cross the eyes in this way and maintain the eyes to converge in. Again, this often results in difficulties looking at near and reading. But, instead of vision being blurry, like we had with accommodative insufficiency, this time things are often double or intermittently double or the letters and images seem to overlap. And it's not uncommon to see some fluctuations with this, either. And just like accommodative insufficiency, some people also experience a pulling sensation with the eyes or even headaches when doing a lot of near work, whether that be reading a book, working on a computer, or looking at their phone. Now, saccades are an eye movement that many people have probably never heard of, but we use them all of the time. Saccades are the ability to move your focus from looking at one target to shifting and looking at another target. And it uses almost every single lobe of the brain in order to accurately move each eye and move them at the exact same speed to look from, again, that one target to the next. So, saccadic dysfunction makes it difficult to maintain focus on almost any task. It makes it difficult to find your place or maintain your place when reading or looking at a spreadsheet, for example. Even right now, uh I bet most people aren't thinking of how much they're using this eye movement, even just to read my facial expressions, right? From reading my lips to looking at my eyes to even just moving from one room to the next, you have to constantly scan your environment. And that's why going to the grocery store is often kind of a nightmare for people because they have to constantly scan to look for items or even just look on the back of an item and try to find where to read the label. And if we're making inaccurate saccades after a concussion, then this can lead to extensive fatigue, dizziness, nausea, and even headaches during any visual task. Either way though, if somebody even just has one of these conditions, then they are likely going to have difficulties with almost any task, especially at near, right? When they're reading, looking at their phone or computer. And so students may end up falling behind or have more challenges in school. And if somebody is challenged visually during a task, it could exacerbate other type of symptoms, things like getting headaches, feeling sick, tired, getting nausea, dizziness, or feeling more light sensitive than usual. And from this short description alone, you can probably imagine how life-altering this can be, even for the most mild of cases. Now again, these are just the three most common eye conditions that are often diagnosed, but there are other symptoms and issues that could be going on as well. Some people have fixation instability issues where they have a hard time maintaining fixation on a single object, or perhaps they have delays in their ability to track moving objects, or they have visual motion issues because they have a difficulty pursuing pursuit eye movements or vestibular ocular motor issues. And again, as mentioned earlier, even referred eye pain and dry eye issues are common. Yeah, this can get really complex. Okay, so now for some good

news. For many people, the majority of post-concussion symptoms do often resolve within the first few weeks after an injury. The downside is of course for the people who don't see that resolution and they have persisting symptoms greater than 3 months then they likely require more targeted treatment for their recovery. And recovery after a concussion is very individualistic not just based on the severity of the concussion or injury itself but also on personal medical factors too. Right, a 19-year-old athlete at the peak of their health with a strong support system is probably going to recover differently than the 48-year-old single mother of three kids that she has to take care of who also has a history of diabetes working two jobs not sleeping, right? They're likely going to recover a bit different. And I'll add here that brain injury doesn't just happen in isolation. In fact, it's now seen as an instigator for other health issues whether that be something like sleep dysfunction or endocrine dysfunction like thyroid disorders. People often not just dealing with the brain injury, they're dealing with the cascade of events that occur after the brain injury. And again, the challenge with the eyes is of course when symptoms don't resolve, right? I found one report showing that about 20% of adolescents after concussion continue to have some form of post-concussion like symptom and then even about 50% of adult TBI cases have some form of visual dysfunction that lasts not only months but potentially years afterward. Okay

so the next big question of course is well, what can be done about it and all of these symptoms? I will say that just in the acute phase if anybody's had injury to an eye or experiencing symptoms of flashes of light, new floaters or any loss of vision, then it's really important to see any general eye care provider as soon as possible, right? Just because you got hit in the side of the head doesn't mean that the eye wasn't involved. If you want to learn more about those specific symptoms, I have other videos on those exact topics and I'll put links to those in the show notes if you want to check them out. And for other post-concussion-like symptoms, then I think it is best to at least seek care or guidance from a family physician. But if a general eye care provider clears that the eyes are perfectly healthy and somebody is still struggling with these post-concussion-like vision symptoms, then I think they might benefit from consulting an eye care professional who

specializes in concussion rehab. Now, I will share that professionals in this space can practice differently. There are still professionals who follow the watch and wait or it will heal with time mentality as that historically had been the standard of care. But in the last decade, research has shown that targeted evaluation and active rehabilitation and management, even early on in the concussion recovery process, can help with the concussion recovery. And with the eyes specifically, many doctors and rehab teams will prescribe vision therapy or eye training exercises to help rehab these visual motion deficits. But just like any other form of physical therapy, I will say that it's not easy and it takes time and consistency does matter, right? You can't just do it once and think it's done. You have to be consistent with it. In addition to this

because the brain is so complex, it often involves not just seeing an eye care provider, but involves seeing a whole interdisciplinary team, meaning also seeing a physiatrist, neurologist, neuropsychologist, a physical therapist, even occupational therapy and speech therapy. So, it's very possible while a person is going through vision therapy for their eye issues and eye symptoms, they may also be actively going through physical therapy for perhaps their whiplash or neck issues. But, I wanted to highlight this because everybody's injury and recovery process is different, and I think it's important to understand how valuable seeking this integrated care experience can be. Even though it can be overwhelming with all the different appointments. Again, I still think it can be a great help. Now, concussion is serious and very complex

and I have a bunch of tips I want to share to help with recovery afterward, but we'll have to save those for another episode. For now, I will put some downloads in the show notes for you that come from the International Brain Injury Association and the Brain Injury Association of America to help with post-concussion recovery type tips. This is an excellent resource because it breaks it down not only for patients, but for providers like myself who want to learn more, but also for caregivers. Again, excellent resource and I'll put that in the show notes. Also, stay tuned because we're going to be bringing on some special guests onto the podcast to talk to us not only about brain injury and concussion, but also TBI rehab. But, if you did find this episode helpful, please consider subscribing or following here if you have not done so already. Not only is it free, but it does greatly show your support for the channel. And if you've made it this far in the video and also have problems with light sensitivity or photophobia, then you may really enjoy this next video I previously made and I'll put this up over here to the side. Thank you so much for watching. Keep an eye on it. And we'll see you in that next video.