Vision and Traumatic Head Injury

by George Dever, O.D., C.O.V.D.; edited by Margaret K. Dore ©

Health care professionals are becoming aware of a long neglected health care concern: physical trauma often causes dysfunction in the visual system even when the eyes themselves are unharmed. Injuries such as closed head trauma or concussion, whiplash injury and stroke have up to a 90% chance of involving a dysfunction in the visual system.

Among the most severe of these visual dysfunctions is double vision. The most common is a weakness in fusion. This can be described as a loss of the ability to effortlessly maintain accurate aiming of the two eyes together. For example, when a person must sustain detailed visual focus for many hours per day—such as reading or computer use, he or she will experience eye strain, intermittent blur, headache and/or difficulty concentrating. Other symptoms include light sensitivity, general fatigue, spatial disorientation and hypersensitivity to all sensory stimulation.

What is surprising is that these symptoms often accompany the milder forms of head trauma. A common scenario is when a person "walks away" from an automobile accident after a minute or less of double vision. Then in the weeks and months that follow, more "subtle" problems begin hampering his or her work or studies.

Mild head or neck injury is extremely hard to diagnose since laboratory evidence is usually absent. Since the injury itself is considered mild, the visual symptoms are expected to disappear without intervention. It is now being recognized that the symptoms usually don’t disappear completely on their own and are best treated with vision therapy as soon after an accident as possible. In my judgment, all accident victims should have a comprehensive vision evaluation by a therapy oriented optometrist (a "developmental" optometrist).

My frustration as a clinician is seeing patients several years after an injury. I have one patient who suffered double vision for five years, and was never referred for vision therapy. The frustrations for the patient are numerous: the road to recovery is very slow; medical professionals differ in their diagnoses and proposed treatments; over time these patients must deal with intense anger and grief over the loss of their previous way of life; patients become tired of doing various therapies; and they often prematurely settle with the insurance company and still need to pay for restorative therapy.

Head trauma, both mild and severe, are challenging conditions for patient and physicians alike. Persons with such injuries are best cared for with a multi-disciplinary approach. We like to see patients who have a primary care physician, a neurologist or a neuro-psychologist, a physical or occupational therapist, a massage therapist, a chiropractor, a psychotherapist and an attorney for legal advice. Those patients are fortunate whose rehabilitation team also includes a developmental optometric physician.

George Dever, O.D., C.O.V.D.