The Connection Between Traumatic Brain Injury and Vision

  
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December 17, 2018, by Bard Optical

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If you’ve experienced a traumatic brain injury (TBI) or know someone who has, you know how serious head injuries can be.

Brain trauma contributes to the death of approximately 50,000 people per year.

The effects of TBI can be short-lived and as mild as a headache, or they last the rest of a patient’s life.

And unlike many health issues, TBI affects children and younger people disproportionately, especially those aged 0 to 4.

TBIs are the result of sharp blows to the head that result in disruption to normal function of the brain, according to the Centers for Disease Control. The CDC notes that “severity of a TBI may range from ‘mild’ (i.e., a brief change in mental status or consciousness) to ‘severe’ (i.e., an extended period of unconsciousness or memory loss after the injury).”

Concussions in which the patient stays conscious during the event can still cause TBI and the associated lasting health effects.

This last situation can actually lead patients to make assumptions that make it harder to diagnose issues that creep up later. Many patients assume that their sensory problems can’t be caused by their head injuries unless they lost consciousness.

Doctors at Veterans Affairs clinics noticed that patients often underreported their exposure to head trauma and blast events unless they had lost consciousness, leading to a delay in getting proper treatment for the sensory aftereffects they experienced.

Many of these sensory aftereffects are visual.

TBI can cause a variety of optical issues, ranging from short-lived symptoms like eye strain and headache to conditions that can cause blindness if left untreated. It is crucial to see your eye doctor following concussions or any events in which TBI is diagnosed or suspected. Even milder changes in vision should be reported immediately, including “fluctuation in... vision, double vision, or difficulty focusing at near or distant objects,” according to Dr. Majid Moshirfar, ophthalmologist at University of Utah.

Evaluation by a professional will ensure that your brain and eyes are working together optimally. Diagnosis can be very tricky because in many cases visual acuity can still be 20/20 and because many neuro-visual impairments don’t show up on a CT scan, so make sure you give your doctor a detailed medical history and list of symptoms you are experiencing following the head injury.

Head injury is known to cause these serious vision issues:

  • Vitreous hemorrhage, in which damaged blood vessels leak into the jelly-like fluid that gives shape to the eyeball.
  • Retinal detachment, a serious problem that can require surgery. Without immediate surgical intervention, retinal detachment has a high chance of causing permanent blindness.
  • Optic nerve damage, another critical situation that can lead to total vision impairment if the pressure is not relieved on this extremely sensitive structure.
  • Post trauma vision syndrome, a neurological condition that includes a host of permanent optical dysfunctions that impair balance and other aspects of sensory integration.

The good news is that most of the problems that optometrists and ophthalmologists see in TBI patients are much less severe and are treatable. Some treatments are as simple as using tinted lenses.

Vision therapy is a common method of addressing some of the visual deficits that result. The principle of such vision therapy is that healthy vision can be developed and strengthened at any age. Even if some visual skills are lost following an accident, such as the ability to track moving objects, or the ability to read smoothly, those skills can be relearned through vision therapy.

Some signs that TBI might be causing optical issues are noticeable, others not as pronounced. The most common symptom is severe photophobia, but that’s present in only about 60% of patients, according to the American Academy of Ophthalmology. Often there is a delay between the trauma and the visual symptoms, so be aware of the following and see you eye doctor right away if these are present:

  • Light sensitivity
  • Blurriness, or changes to visual clarity
  • Double vision
  • Decreasing peripheral vision
  • Cognitive issues, such as trouble with comprehension, memory, and attention
  • Headaches and aching eyes with close work or reading
  • Reading difficulties from words seeming to move on the page
  • Feelings of motion sickness or nausea when changing focus quickly

The bottom line for head trauma patients is that optical symptoms should be checked out in depth by your eye doctor as quickly as possible.

And regular eye exams don’t usually test for the kinds of issues TBI patients suffer, so be as open and complete in sharing information with your doctor as you can.

Unlike your brain, your eyes don’t have a protective case surrounding them like the brain has a skull of protective bone.

Remember they are sensitive, and get them checked out following concussions, car accidents, sports injuries, or any other incidents involving head injury.

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