Post-Traumatic Vision Syndrome

Post-traumatic vision syndrome refers to a constellation of visual symptoms that can occur after traumatic brain injury (TBI) or concussion. Even when the eyes and basic vision are normal, patients may experience significant visual symptoms because the brain's ability to process visual information has been disrupted.

Understanding Post-Traumatic Vision Syndrome

Vision is more than just seeing clearly—the brain must coordinate eye movements, maintain focus, process visual information, and integrate vision with balance. Head injury can disrupt any of these functions without damaging the eyes themselves. This is why standard eye exams may be "normal" while patients still experience significant visual problems.

Symptoms

Common Visual Symptoms

Eye movement and coordination problems:

• Double vision
• Difficulty tracking moving objects
• Eyes feel like they don't work together
• Losing place while reading

Focusing problems:

• Blurred vision, especially near
• Difficulty shifting focus between distances
• Eye strain with close work

Visual sensitivity:

• Light sensitivity (photophobia)
• Visual overwhelm in busy environments
• Motion sensitivity

Reading difficulties:

• Words move or blur on page
• Losing place frequently
• Quick fatigue with reading
• Comprehension problems

Associated Symptoms

• Headache with visual tasks
• Dizziness and balance problems
• Nausea with visual activity
• Fatigue
• Difficulty concentrating

When Symptoms Occur

• May appear immediately after injury
• May develop days to weeks later
• Often persist after other concussion symptoms resolve

Underlying Problems

Convergence Insufficiency

• Difficulty turning eyes inward for near focus
• Common after TBI
• Causes double vision or strain at near

Accommodative Dysfunction

• Difficulty focusing at near distances
• Eyes don't adjust focus normally
• Causes blurred near vision

Oculomotor Dysfunction

• Poor control of eye movements
• Affects tracking, scanning, reading
• May cause oscillopsia

Visual Processing Problems

• Difficulty with visual-spatial tasks
• Trouble with visual memory
• Problems with visual attention

Diagnosis

Comprehensive Eye Examination

Beyond standard testing:

• Convergence and divergence testing
• Accommodative testing
• Eye movement (saccade and pursuit) evaluation
• Visual processing assessment

Symptoms Often Missed

Related Evaluations

• Neurological assessment
• Vestibular evaluation (balance)
• Cognitive testing
• Occupational therapy assessment

Treatment

Vision Therapy

Most effective treatment for many patients

• Exercises to improve eye coordination
• Convergence training
• Accommodative exercises
• Oculomotor training
• Often requires specialized therapy

Glasses and Lenses

• Reading glasses (for accommodative problems)
• Prism glasses (for eye alignment or convergence problems)
• Tinted lenses (for light sensitivity—FL-41 often helpful)
• Blue-light filtering

Environmental Modifications

• Reduce screen time
• Adjust lighting
• Take frequent breaks
• Minimize visual clutter
• Use larger text

Lifestyle Modifications

• Adequate sleep
• Pacing of activities
• Gradual return to visually demanding tasks
• Stress management

Prognosis

Generally Favorable

• Most patients improve with treatment
• Vision therapy effective in 60-80% of cases
• Improvement may continue for months to years
• Some patients achieve full recovery

Factors Affecting Recovery

• Severity of initial injury
• Age
• Prior visual problems
• Participation in treatment
• Time since injury

Living with Post-Traumatic Vision Syndrome

Practical Tips

Reading:

• Use larger text
• Cover surrounding text
• Take frequent breaks
• Use audio alternatives when possible

Screen use:

• Reduce brightness
• Use dark mode
• Limit screen time
• Take regular breaks (20-20-20 rule)

Environment:

• Reduce clutter
• Control lighting
• Avoid busy visual environments when possible

Activities:

• Pace yourself
• Recognize warning signs of visual fatigue
• Rest when needed

Work and School

• May need accommodations
• Extended time for reading tasks
• Modified lighting
• Breaks as needed
• Audio alternatives for reading

Frequently Asked Questions

Why didn't my regular eye exam find anything wrong?

Standard eye exams focus on visual acuity (clarity) and eye health. Post-traumatic vision syndrome involves problems with eye coordination, focusing, and processing that require specialized testing to detect.

Will this get better on its own?

Some symptoms may improve spontaneously, but many patients have persistent symptoms that benefit from treatment. Vision therapy can significantly speed recovery and improve outcomes.

Is this permanent?

No—most patients improve with appropriate treatment, and many recover fully. Even those with persistent symptoms can usually be helped significantly.

Can I drive?

This depends on your specific symptoms. If you have double vision, significant visual field issues, or severe symptoms that impair visual processing, driving may not be safe until these improve. Discuss with your doctor.

Why is reading so hard if my vision is "normal"?

Reading requires precise eye movements, coordinated focusing, and sustained visual attention—all functions that can be disrupted after head injury. Your basic vision (acuity) may be fine, but the visual processing needed for reading is impaired.

References