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Visual Disturbances After Concussion

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Abstract

Purpose of Review

Concussion frequently results in visual symptoms, necessitating careful neuro-ophthalmic examination. Both afferent and efferent visual systems are sensitive to brain injury. The present review focuses on the pathophysiology, clinical presentations, examinations, management, and future directions regarding visual disturbances after concussion.

Recent Findings

Photophobia is common in both acute and chronic concussion. Abnormalities of accommodation, convergence, saccades, and smooth pursuits can result in blurred vision, double vision, and difficulty with near work. Vision-based testing is crucial in the detection of concussion. Retinal nerve fiber layer thickness measurement may elucidate the risk of structural and functional sequelae. Patients presented with visual field loss or cranial neuropathies require evaluation for structural lesions.

Summary

Proper neuro-ophthalmic examination is instrumental in clinical decision-making for the diagnosis and management of concussion, as well as directing future investigations on preventing long-term complications.

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Abbreviations

TBI:

Traumatic brain injury

IPRGC:

Intrinsically photosensitive retinal ganglion cell

CI:

Convergence insufficiency

NPC:

Near point of convergence

RAN:

Rapid automized naming tasks

KDT:

King-Devick test

MULES:

Mobile Universal Lexicon Evaluation System

OCT:

Optical coherence tomography

RNRL:

Retinal nerve fiber layer

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Authors and Affiliations

  1. Department of Neurology, Jefferson Einstein Hospital, PA, Philadelphia, USA

    Shuai-Chun Lin

  2. Department of Ophthalmology, Temple University Hospital, Philadelphia, PA, USA

    Shuai-Chun Lin

  3. Department of Orthopaedic Surgery, Nemours Sports Medicine, Nemours Children’s Hospital, Delaware, DE, Wilmington, USA

    Alvin W. Su

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Lin, SC., Su, A.W. Visual Disturbances After Concussion. Curr Phys Med Rehabil Rep 11, 384–392 (2023). https://doi.org/10.1007/s40141-023-00417-3

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