Ocular/Eye Injuries

Lt Col Reynolds
In many cases, patients with traumatic brain injury also have problems with their vision. These problems can result from injury to the eye, the optic nerve, or to the brain itself. Dr. Green, can you tell us about some of the ocular and eye injuries often associated with TBI?

Dr. Green
Definitely, Dr. Reynolds. Injuries to the eye that occur in connection with TBI are often the result of flying debris entering the eye, or a direct blow to the eye. A direct blow to the eye can cause the eye to rupture, or it can cause internal damage to the eye, which can only be seen with special instruments. These eye injuries may require surgery soon after they occur to remove debris from the eye and, when possible, repair damage to the structures inside the eye.

One of the most common causes for loss of vision following head trauma is traumatic optic neuropathy. This condition involves damage to the optic nerve, which is the nerve that provides the ability to see. Patients with traumatic optic neuropathy can experience sudden vision loss. In some cases, the injury is apparent hours, days, or even months after the incident. In other cases, the damage may not be detected until an eye examination is performed by a healthcare provider.

Other vision problems can result from damage to the occipital lobes in the back of the brain. The signals from the eyes are received by the occipital lobes, and these signals are used to form and interpret images. Damage to the occipital lobes can make it impossible to understand what the eyes are seeing, or cause a type of blindness known as cortical blindness. 

The brain also controls the movements of the eyes. Damage to the part of the brain that controls those movements can cause a number of problems such as double vision and difficulty following a moving object or reading and tracking words on a page.

Some of the visual problems that patients with TBI can experience include:

• Blurred vision
• Reading difficulties
• Sensitivity to light
• Difficulty understanding images
• Double vision
• Headache following visual tasks
• Reduction or loss of peripheral vision
• Difficulties with eye movements, such as:
  • Problems shifting gaze quickly from one point to the other
  • Challenges focusing, and
  • Problems with eye alignment