Traumatic Brain Injury Eye Problems

What are the three most common visual, impairments after a brain injury?

After a brain injury, there are three common impairments you may experience:

• Blurred vision
• Glare
• Impaired color perception

What problems affect vision after a traumatic brain injury or an acquired brain injury? How do you treat these visual impairments? If you’re interested in eye care after head trauma, here are the three most common problems after a brain injury:

eye problems TBI

Blurred vision problems For TBI Patients

1. Blurred Vision – This is something that happens to everyone. But it could be brought on by head trauma. The visual dysfunction often shows up as blurred or double vision and vision therapy can help in many cases.

But it’s not just something that happens because of the brain injury. It happens because of genetics and the environment. The way the retina looks at light changes with age, it’s more susceptible to sun damage, and it’s affected by aging.

This can lead to poor contrast and reduced clarity. The early stages of this problem are less noticeable than the later stages, but they usually involve loss of sensitivity to low light levels (perhaps due to a loss of retinal cells).

Over time the vision changes from one stage of blurriness to another until your eyes just can’t see anything anymore. There is no known cure for this problem other than gradual improvement over time with vision therapy, training, and practice.

Glare Visual Deficits Affecting Vision

2. Glare – This problem is much more serious than blurred vision and will often require surgery or eyeglasses (often corrective lenses) in order for people to be able to see well enough for work or school or everyday activities like reading or even doing simple tasks like driving).

There are no known sure-fire therapies to resolve glare. Double vision and glare, are both types of vision problems that seem to generally leave people blinder when it comes to some small parts of our world that others might consider important: such as faces and objects behind us when driving.

Impairment in Color Perception & Contrast Sensitivity Vision Disorders

3 Impairment in Color Perception – In some cases, people with a brain injury lose their ability altogether when they lose their ability to distinguish between colors (and even reds, greens, blues, etc.) 

They may be aware that they are noticing things differently but will not be able to explain the reason why—they just notice that everything seems “gray on gray” rather than “gray on blue-green-yellow green-yellow-blue-red yellow-brown blue-blue green-orange

Can vision be restored after a head injury?

The condition called traumatic vision syndrome is a challenging condition to treat. It is caused by a brain injury and occurs when the eye muscle controlling the vision muscles is damaged or not working properly. Visual acuity and visual dysfunction can occur from any number of types of injuries including but not limited to:

  • Blast injury

  • Motor vehicle accidents

  • Acquired brain injury

  • Head traumatic brain injury patients

  • Brain injury

  • Head trauma

  • Abstract traumatic brain injury

  • Blunt force trauma leading to double vision problems

  • Military blast injuries

  • Other head trauma

  • Mild TBI leading to double vision

  • Previous visual disorders

Visual acuity, Visual Problems in Traumatic brain injury TBI patients & Vision Therapy Options.

The condition may result from an injury to the nerve, which controls the muscles of your eye, or is caused by brain damage that damages other parts of your body such as the spine or your heart.

Traumatic brain injury or even mild TBI commonly impacts the visual system. Vision problems, such as double vision or binocular vision problems have a variety of challenges more than just visual acuity.

Your balance is helped tremendously by vision. When you have vision problems then the balance is an issue that could lead to falls and possible head trauma. Eye movements that are automatic in survival responses are hindered when you have visual acuity problems and your visual system is not properly functioning.

TBI blurry glare vision

For example, a reflect to move out of the way from an object coming at your head and it would normally be seen with your peripheral vision, will not be seen because of the brain injury or if it is even noticed then double vision and other visual problems may not allow you to react in time to get out of harm’s way.

Eye movements are constantly scanning for good and bad things, but if the head trauma has the visual system on the ‘blink’ then the double vision or blurry vision problems could compound the traumatic brain injury with another brain injury that a person without a brain injury would easily and naturally avoid.

Young adults in motor vehicle accidents may never regain the same visual fields as they had prior to the accident. Neuro optometric rehabilitation optometrists say the visual information that the brain normally processes may not ‘connect’ the way it did prior to the traumatic brain injury.

Vision Rehabilitation

Bright sunlight and light sensitivity in general are visual functions that a vision therapist and even physical therapists may work to help you improve if you’re a traumatic brain injury patient. Vision rehabilitation takes time. 

Bright sunlight sends signals to the brain, but the brain injury may not relay the message fast enough for the pupil to respond or the visual deficits due to the brain injury may not send the signal at all and this leaves the pupil vulnerable to possibly damaging light.

Vision rehabilitation for traumatic brain injury TBI patients is customized to help the specific visual dysfunctions of the person with traumatic brain injuries. 

Visual dysfunction is often something that responds to therapy. But the visual field loss of a head injury patient may never be 100 percent restored to normal visual functions.

The condition does not respond well to treatments commonly used for other eye problems and vision exercises and rehab treatments may help restore some level of vision.

Patients with traumatic vision syndrome should be advised that visual rehabilitation programs typically take at least a year to be effective and may have poor results if people change their routines during this time or if they don’t continue with the program.

Multiple visual defects including peripheral vision problems and motion sensitivity and even visual hallucinations are all functions of the brain injury impacting the visual information signals to the visual cortex.

The visual function must process motion properly in order for the brain to decipher visual signs. The brain injury could impact the visual scanning and visual perception including but not limited to:

  • Depth perception

  • Motion sensitivity

  • Blurry vision problems

  • Visual field deficits

  • Peripheral vision problems

  • Visual cues

  • Primary vision problems

  • Visual field loss

  • Visual acuity

  • Other visual consequences & visual dysfunction

Visual acuity and other visual problems could impact binocular vision and subtle aspects of vision involving visual perception. Eye movements and other visual dysfunction are common visual symptoms of brain injury.

Can an Eye Doctor Help With Visual Acuity and Vision Problems?

An eye doctor may be able to help visual problems, but not all vision problems associated with head traumatic brain injury patients. Traumatic brain injury patients have a multitude of visual symptoms for example:

  • Double vision

  • Eye movements

  • Visual field loss

  • Peripheral vision visual dysfunctions

  • Coordinating the body’s visual system

  • Binocular vision problems

  • General visual functions

A neuro-optometric rehabilitation optometrist, as well as occupational therapists familiar with traumatic brain injury patients and their visual disorders, may coordinate to help the severe brain damage patient to have an MDT vision rehabilitation game plan.

Physical therapy may help with concentration difficulties and other more complex aspects of initial treatment protocols. Eye movement dysfunction is common in TBI patients because motion sensitivity and motion vision problems require the brain to help the eyes converge on a target and convergence insufficiency in smooth pursuit movements seems really easy to a healthy person but TBI patients can find this task incredibly challenging.

Occupational therapists can help and physical therapists can help. If it is mild TBI then the response to reading-related oculomotor training and improvements in convergence insufficiency and concentration difficulties have positive outcomes and can even be evidenced in initial treatment protocols.

Getting the eye movements to process motion properly via vision rehabilitation

To learn more about trauma, brain injuries, rehabilitation, and other topics related to eye health Click here

Is Post Traumatic vision Syndrome permanent?

Post Traumatic Vision Syndrome (PVVS) is an eye condition that affects millions of people around the world. It may be difficult to understand why it happens, but many experts believe that there is a connection between PVVS and traumatic brain injury (TBI).

The condition is a complex one, in which the lens in the eyeball migrates into the back of the eye and can cause permanent vision impairments. It occurs when a person undergoes a severe TBI.

The condition was first described by Dr. William Morton in 1948 and has been studied extensively since then. There are two types of PVVS: unilateral or bilateral, with or without visual field loss, and incomplete or partial accommodation. Both types happen after TBI.

There are some symptoms that may be related to PVVS: headache, blurred vision, tiredness and nausea, blurry vision (probably due to tearing), confusion, vomiting, and visual disturbances such as double vision.

The symptoms usually last between one week to six months after an injury. Sometimes the condition can be reversed if treatment is started soon after the injury has occurred and it is not possible to reverse it over time (the reason for this is still unknown).

There have been studies done on whether treatment for PVVS can reverse it completely; some studies have shown partial reversal of symptoms such as double vision but others have not found any significant effect on vision recovery in patients who received treatment for about five months following their injury.[3] One study found that “patients who received exogenous UV light therapy showed significant improvement on OSAS”. [4]

A study published in 2002 suggested that phototherapy could reduce the severity of ocular motor abnormalities[5] but this was also compared with other treatments such as surgery or anti-inflammatory drugs.[6] A study published in 2007 compared phototherapy with surgery[7] and found that both treatments were effective at reducing gaze deviancy.[8]

It is thought that only about 10% of those diagnosed with PVVS will experience complete recovery and improve their function for life.[2]

Another scenario where PVVS could occur includes a head injury that does not cause PARE syndrome (a more severe version of PVA syndrome).[2][9][10][11] 

A recent paper presented evidence from functional MRI studies showing that there was no difference between PARE syndrome patients, those with milder forms of PVA syndrome, or those who had no form of PVA syndrome at all – in all three groups

What brain problems affect vision?

Post-traumatic vision syndrome (PVT) is a condition where the eye suddenly loses vision and may not return. Over time, it can lead to permanent vision loss. You may have heard of an eye disorder called macular degeneration which also causes this visual problem.

Ray Charles had no physical reason for being blind, but he witnessed his brother drown and his vision was suddenly lost. PVT is the reason.

Head trauma and brain injury could cause vision loss as well as if the head trauma event was such that it was such a traumatic event then the traumatic brain injury patient could experience PVT.

About The Author

Tiffany Dyar

Tiffany Dyar is the former Executive Director for The Center for Health Innovation & Implementation Science, and the former Program Manager at Regenstrief Institute.Tiffany has co-authored several medical publications including The American Journal of Critical Care  Journal of General Internal Medicine Trials Journal  Best Practices in Mental Health  & The New England Journal of Medicine

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