Can a mild concussion cause lasting visual symptoms?

Mild Concussion Can Cause Lasting Visual Symptoms

Yes, mild concussion can cause lasting visual symptoms that may persist beyond the acute injury phase and require specialized treatment. 1 Clinical evidence shows that visual symptoms are among the most common persistent post-concussion symptoms, with oculomotor visual therapy showing positive effects in patients with persistent visual symptoms after concussion.

Common Visual Symptoms After Concussion

Visual symptoms following mild concussion include:

• Photophobia (light sensitivity) 2
• Blurred vision 3
• Difficulty with visual focus 1
• Convergence insufficiency 4
• Accommodation problems 4
• Eye strain and fatigue 1
• Problems with saccades (rapid eye movements) 3
• Difficulty with screen time and reading 1
• Double vision 1
• Visual-derived nausea 1
• Difficulty judging distances 1
• Difficulty tolerating complex visual environments 1

Duration and Persistence

While most concussion symptoms resolve within the first three months post-injury 5, visual symptoms can persist longer in some patients:

• Photophobia may persist for approximately 6 months or indefinitely in some cases 2
• Visual symptoms are among the most common symptoms in post-concussion syndrome 1
• Patients with ocular-motor subtype of concussion often experience persistent visual dysfunction 1

Evaluation and Diagnosis

For patients with persistent visual symptoms:

1. Assess for specific visual dysfunctions:

   • Convergence distance
   • Accommodation
   • Saccades
   • Smooth pursuit
   • Eye tracking 4

2. Look for signs of the ocular-motor subtype of concussion:

   • Difficulty with visual activities
   • Asthenopia (eye strain)
   • Problems with visual focus
   • Photophobia
   • Blurred or double vision 1

Treatment Recommendations

For patients with persistent visual symptoms after concussion:

1. Oculomotor visual therapy is recommended for treating persistent visual symptoms after concussion. 1 Clinical experience shows this therapy improves visual symptoms and reduces associated symptoms like headache and fatigue.

2. For patients with photophobia:

   • Consider specialized tinted glasses (such as FL-41 rose-colored lenses) 2

3. For patients with persistent symptoms beyond 3 months:

   • Refer for multidisciplinary evaluation and treatment 6
   • Consider vestibular rehabilitation for patients with vestibulo-oculomotor dysfunction 6

4. Interdisciplinary coordinated rehabilitative treatment:

   • The 2021 JAMA Network Open guideline provides a weak recommendation for interdisciplinary coordinated rehabilitative treatment that includes oculomotor vision therapy 1
   • Treatment should be administered at least once weekly for a minimum of 4 weeks 1

Important Considerations and Pitfalls

1. Visual symptoms may mimic cognitive impairment: Deficits in the ocular-motor system can functionally mimic cognitive impairment and are frequently found in conjunction with vestibular symptoms 1

2. Delayed recognition: Visual symptoms may be overlooked in initial assessment, leading to delayed treatment and prolonged recovery 3

3. Comorbid conditions: Visual symptoms often co-exist with other post-concussion symptoms such as headaches, cognitive difficulties, and vestibular issues 1

4. Return to activities: Patients should be advised to avoid activities that exacerbate visual symptoms during recovery and follow a gradual return to activity protocol 6

5. Red flags requiring immediate attention:

   • Acutely worsening visual symptoms
   • New neurological symptoms
   • Severe headache with visual disturbances 6

Visual symptoms following mild concussion can persist and significantly impact quality of life, but appropriate evaluation and targeted interventions like oculomotor visual therapy can effectively manage these symptoms and improve outcomes 1.