Considering an estimated 475,000 children under the age of 14 experience traumatic brain injuries every year, it is no wonder we see these cases frequently at Lang Family Eye Care. When a concussion occurs, it can result in temporary or long-lasting vision-related symptoms. Since these problems might not surface immediately post-injury, you may not even realize they are related. Visual symptoms might develop gradually over time or only show up under stressful conditions, affecting everything from eye movement to visual acuity.
If you or your child has recently experienced a head injury, vision may not be the first thing on your mind. However, it is important not to overlook the potential vision disorders that even a minor head trauma can cause. Here, we cover the ins and outs of traumatic brain injury and related visual dysfunction so you can recognize and address these problems right away.
What is Traumatic Brain Injury?
Traumatic Brain Injury (TBI) is a severe health condition that can originate from a forceful impact on the head or body or an object piercing the skull and reaching the brain. However, not every strong impact or jolt leads to TBI. Certain forms of TBI may cause temporary or short-lived issues affecting standard brain functions such as thinking, understanding, movement, communication, and behavior. On the flip side, traumatic brain injury patients with severe cases can cause permanent disabilities and, in the worst-case scenario, lead to fatality. Injuries can be primary, causing immediate damage, or secondary, resulting from reactive processes post the initial trauma and may appear gradually.
Broadly, there are two types of head injuries: Penetrating and Non-penetrating. Penetrating TBI occurs when an object pierces the skull and enters the brain, whereas Non-penetrating TBI involves an external force strong enough to disrupt the brain within the skull. This could be attributed to various causes like falls, accidents, sports injuries, blast injuries, or being struck by an object. Some incidents, such as severe car accidents, can potentially cause both types of TBI.
Symptoms of Post-Concussion Vision Problems
If you or your child has recently experienced a concussion, it’s important to understand the potential for eyesight difficulties. Even a mild traumatic brain injury can lead to vision problems. Recognizing the types of eye-related concussion symptoms can empower you to seek help from an eye care professional, like your Lang Family eye doctor, if they persist.
Blurry or Double Vision
Two of the most common vision symptoms after an injury to the head are blurry or double vision. Blurry vision is caused when the alignment of the eyes diverges when focusing on nearby objects. As a result, the person may experience poor balance, dizziness, or difficulty reading.
Similarly, someone with a head injury may experience diplopia, also known as double vision. This is when a person sees two images of an object instead of one. Often, it is caused by trauma to the optic nerve, orbital bones, or the muscles surrounding the eye. Blurry and double vision are due to an interruption in eye-brain communication.
Photophobia
Photophobia, also known as light sensitivity, is one of the most common symptoms of a concussion. It is believed that approximately 43% of individuals experience photophobia after even mild head trauma. Furthermore, the majority of patients rate their photosensitivity as severe. Bright sunlight or fluorescent lighting may be extremely discomforting, and even using a computer screen or smartphone may aggravate headaches. If you’re experiencing light sensitivity, read our article about photophobia for more information about this condition.
Vision Loss
In some instances, severe traumatic brain injury could also cause more direct eye injuries, resulting in partial or complete vision loss. Damage to the optic nerve can lead to this condition. In particular, TBI can lead to damage to the optic nerve, optic tract, and occipital lobe, which can cause decreased peripheral vision.
Eye Pain
Traumatic brain injury may result in eye pain that ranges from stabbing pain to a dull ache around the eye. Head trauma can also result in redness, burning, or itching around the eyes or headaches that include pain behind the eyes. In rare cases, this eye pain can last for up to a year after the brain injury.
Impaired Eye Movements
Concussions can also impair your eye movements, leading to delayed or slow eye movements. This may hinder the ability to track moving objects or shift gaze from one object to another. Trouble focusing while moving your head could be due to a disturbance in the Vestibular Ocular Reflex (VOR). Normal VOR function is necessary for carrying out activities of daily living like walking and is especially crucial for higher-demand activities like sports.
Vertigo
Up to 80% of traumatic brain injuries result in dizziness or vertigo. Experiencing vertigo or discomfort in visually busy settings may indicate post-concussion vision motion sensitivity. This occurs when the central nervous system struggles to process complex visual stimuli and usually resolves within a few weeks after the injury.
Visual Signs of Concussions in Children
Understanding a child’s health regarding injuries is crucial for parents or caregivers. One of the common injuries that can occur from a direct blow to the head, face, or body is a concussion. In children, concussions can temporarily disrupt the normal functioning of the brain.
It’s important to remember that a child doesn’t necessarily have to lose consciousness to have a concussion. Even a jerk to the head resulting from a body impact can lead to this type of head injury. Therefore, if a child is suspected of having a concussion, the safest course of action is to halt play immediately. Ideally, the child should not return to normal activities until all symptoms have subsided—a simple rule to remember is, “If in doubt, sit it out.” Healing from head injuries takes time, and concussions are no exception. Once a concussion occurs, children require ample rest from physical and mental activities to recover properly, typically for a day or two.
It is critical to recognize the signs of a concussion in children. At Lang Family Eye Care, we encourage our clients to focus on visual signs that their children may display.
Closing One Eye and Poor Depth Perception
Some children may show signs of double vision, or diplopia, due to an imbalance in the eye muscle movements. This misalignment causes children to see double images, which can lead to them closing one eye or having problems with balance or depth judgment.
Favoring One Side
Another sign to look out for is a visual field defect or hemianopia. This defect results in vision loss in half of the visual field in each eye due to an interruption of the visual pathways in the brain. Children might bump into objects on one side, ignore one side, or draw only on one page.
Squinting
A child with a concussion may also have a squint or strabismus, where the eyes are not correctly aligned. Affected children may tilt or turn their heads to line the eyes up, as the eyes cannot make this correction on their own.
Poor visual acuity, or unclear vision, is another common symptom of a concussion. We use special eye charts with letters or pictures at our Lang Family Eye Care office that can help test this condition in children who can’t read or name letters.
Dizziness or Balance Problems
Finally, children may experience dizziness or balance problems due to difficulties in focusing their eyes. You may notice your child stumbling or falling easily.
Treatment of Visual Dysfunctions After TBI
Vision problems can be a complex consequence of head trauma, especially in children and adolescents. Integrating these young individuals back into the academic setting following a concussion requires careful management of their vision deficits. A comprehensive and active approach, including both task modifications and specialist referrals, appears to be key in managing vision problems following head injuries in children and adolescents.
Behavior Modification
In the aftermath of a concussion, modifying activities temporarily is crucial. This can involve reducing the time spent on visual work and reading, using preprinted notes or audiobooks, temporarily employing reading glasses, and limiting time on electronic screens. Other strategies include practicing visual pacing (taking breaks from visual work to manage symptoms), using an enlarged font or double spacing, blocking sections, adjusting device brightness, and gradually returning to the full visual workload over the recovery period. These strategies aim to decrease external environmental stressors, such as bright lights or the intensive use of electronic screens, that can exacerbate vision impairment after a concussion.
Specialty Care
Simultaneously, comprehensive multidisciplinary management of a concussion is paramount. This involves a referral to the appropriate specialists with expertise in comprehensive concussion management. These specialists may include sports medicine practitioners, physiatrists, neurologists, neuropsychologists, ophthalmologists, and otorhinolaryngologists.
When we see a child or adult with blurred vision when reading following a head injury, we may recommend several options. These include:
- Patching — Double vision may be treated by placing a patch over one eye or one part of the eye.
- Prism Lenses — We also prescribe prism lenses to treat binocular vision problems, including double vision. These lenses can also treat dizziness and problems with balance.
- Specific Prescription Lenses — These lenses improve visual acuity that may be impacted after a concussion.
- Vision Therapy — In some cases, we refer patients to visual therapy. This personalized program improves visual skills, including hand-eye coordination, eye tracking, peripheral vision, focusing, and depth perception.
Vision and Traumatic Brain Injury FAQ
Many of our clients are understandably concerned about their child’s head trauma and potential complications. Here are some of the most common questions we hear from our Lang Family Eye Care clients:
What is the difference between a concussion and TBI?
According to the Centers for Disease Control and Prevention (CDC), both are brain injuries, but they differ in severity. A concussion, often referred to as a mild traumatic brain injury (mTBI), is caused by a sudden movement, such as a blow or jolt to the head, that makes the brain bounce or twist in the skull. This abrupt motion can stretch or damage brain cells and induce chemical changes in the brain. While there might be visible signs like bruising or cuts, concussions are ‘invisible injuries’ and may not cause a person to lose consciousness. In contrast, a TBI can be more severe, encompassing concussions and deeper, potentially life-threatening brain injuries. The crucial note is that despite being termed ‘mild’, concussions are serious and require proper rest and care to avoid any risk of further injury. Any level of TBI can cause visual problems.
What causes a head injury in a child?
Head injuries in children can occur from various circumstances and are often frequent among the adolescent population. These injuries are twice as likely in males than females, most common during the spirited spring and summer months, and occur frequently during late afternoons, early evenings, and weekends when kids are more active.
The main causes of these injuries include falls, motor vehicle accidents where the child is either a passenger or pedestrian, and, sadly, instances of child abuse. We also see a higher frequency of head injuries in children engaging in outdoor activities such as bicycling, in-line skating, or skateboarding.
Damage to the brain, including bruising and internal tissue injury, can occur from a direct blow to the head, a whiplash-type injury, or shaking of the child. These injuries can lead to internal bleeding, bruising, or brain swelling. Thus, it’s crucial to be aware and take protective measures, especially for children engaged in sports like football, soccer, hockey, and basketball, where the risk of concussion is higher.
What is Post-Trauma Vision Syndrome?
The human body is an intricate network of systems functioning together harmoniously. However, when any part of this network encounters a disruption, the balance gets affected, and one such catastrophic disruption is a traumatic brain injury (TBI). The scope of TBI’s impact extends beyond the brain itself, striking one of our most important senses—vision. This effect gives rise to what is known as Post-Traumatic Vision Syndrome (PTVS).
PTVS can occur following various incidents involving injury to the brain. The trauma inflicted upon the brain influences an individual’s vision depending on the areas of the brain and external eye structures involved. Alongside, muscle imbalances in the extraocular muscles, responsible for aligning our eyes, can also impact visual function.
The vision comprises both motor (movement-related) and sensory (perception-related) components, and a dent in any of these can lead to PTVS. A well-regulated visual system allows us to perceive and process information effectively. However, any disturbance in this balance can cause an altered ability to comprehend and process visual and sensory feedback, leading to notable dysfunction in vision.
Numerous symptoms can be observed in the wake of a neurological insult. These may include headaches, diplopia (double vision), dizziness, asthenopia (eye strain), photophobia (light sensitivity), vertigo, and even difficulties in focusing and tracking objects.
These symptoms tend to be alleviated in the morning but worsen with activity and visually stimulating environments. Sleep disturbances are also observed in individuals with PTVS, adding to the discomfort and disruption of normal life.
How long do visual problems last after a concussion?
Most concussion-related vision problems occur within 1–2 weeks after the incident and will usually resolve on their own without the need for treatment. In some cases, children or adults may have persistent visual symptoms over a month after their head trauma. In these cases, we recommend seeing your Lang Family Eye Doctor as soon as possible. (Click to schedule an appointment.) If you are experiencing other lingering symptoms after an impact to the head, see your primary care physician, who may refer you to a TBI specialist.
Can a concussion permanently change your vision?
The risk of permanent vision loss after a head injury is a significant concern that should not be taken lightly. With each brain injury being as unique as the individual it affects, the process of recovery can be complex and subjective. Even if the initial trauma seemed minor and there were no obvious neurological symptoms, it’s important to understand that permanent visual loss could continue to develop if left untreated.
Visual loss can result from a wide range of lesions affecting multiple levels of the visual system and may remain concealed behind a lack of overt signs of trauma. Prompt and thorough examination, coupled with the right neuroimaging, is vital in determining the cause of the visual loss and initiating effective management. We take the urgency of diagnosis and treatment very seriously at Lang Family Eye Care to mitigate the risk of permanent damage.
Get Your Head Back in the Game at Lang Family Eye Care
Even a mild head injury can cause significant vision problems that affect daily life. Fortunately, most vision problems are not permanent and can be managed with proper treatment. However, it is always best to be evaluated right away to avoid serious complications.
Your Lang Family Eye Care Doctors are well-versed in diagnosing and treating visual symptoms following a head trauma. If you or your child has recently experienced a head injury, even if it seemed mild, schedule an appointment at our office in New Berlin, WI. You only get one head, so don’t delay making sure it’s a-ok!
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