Eye Strain and Visual Symptoms After Concussion

If reading feels harder than it used to, if screens make your head pound, or if your eyes feel exhausted by the end of the day, you’re not imagining it. Visual symptoms are among the most common and most disruptive effects of a concussion, and they often stick around long after other symptoms have improved.

At Fredericton Family Chiropractic, Dr. Scott Brayall uses a combination of chiropractic care and functional rehabilitation to address the root causes of post-concussion visual problems, not just the symptoms.

What Post-Concussion Visual Symptoms Feel Like

Visual symptoms after a concussion go way beyond blurry vision. You might notice eye strain or fatigue, especially when reading or using screens. Maybe it’s hard to focus on close-up tasks, or you’re dealing with blurred or double vision. Some people describe words appearing to move or swim on the page. Light sensitivity can make bright environments feel completely overwhelming. You might get headaches that build behind the eyes, or have difficulty tracking moving objects. Busy visual environments like grocery stores or shopping centres might make you feel overwhelmed or dizzy. A lot of people find themselves needing to re-read sentences multiple times or constantly losing their place while reading.

These symptoms can make work, school, and even simple daily tasks feel exhausting. Many people assume they need a new glasses prescription, but in most cases the problem isn’t with the eyes themselves. It’s with how the brain and neck are processing visual information.

Why Concussions Affect Your Vision

Your visual system is far more complex than your eyeballs. Seeing clearly depends on precise coordination between your eyes, brain, and vestibular system. A concussion can disrupt this coordination in several ways.

Oculomotor Dysfunction

After a concussion, the muscles that control eye movement can lose their precision. This affects three key functions.

Convergence is the ability of both eyes to focus on a close object. When convergence is impaired, reading becomes difficult and you may experience double vision or eye strain during near-work tasks.

Smooth pursuit is the ability to follow a moving object smoothly with your eyes. When this is disrupted, your eyes jump rather than track smoothly, making it hard to follow a ball, read a line of text, or watch a video.

Saccades are the quick, accurate eye movements you use to shift focus from one point to another. When saccades are impaired, reading becomes slow and effortful because your eyes struggle to jump accurately from word to word.

Research shows that up to 40% of people who have sustained a traumatic brain injury experience some form of visual dysfunction. These problems are often measurable on clinical testing even when a standard eye exam comes back normal.

Visual Motion Sensitivity

A lot of people with post-concussion visual symptoms find that busy environments like stores, restaurants, or scrolling on a phone make everything worse. This is called visual motion sensitivity, and it happens when your brain struggles to process complex visual input efficiently. The result is often dizziness, nausea, headache, and a strong urge to close your eyes or leave the environment.

The Neck-Eye Connection Most People Miss

Here’s something that surprises most patients. Many post-concussion visual symptoms are driven not just by the brain, but by the neck.

Your cervical spine is packed with sensory receptors called proprioceptors that communicate constantly with your brain about head position and movement. These signals are tightly integrated with your visual system through something called the cervico-ocular reflex. When your head moves, your neck sends signals that help coordinate eye movement.

When a concussion also injures the cervical spine (which it almost always does), these proprioceptive signals become unreliable. Your brain receives conflicting information about where your head is and how it’s moving. The result can include blurred vision, difficulty tracking, eye strain, and dizziness. These symptoms look like a brain problem but are actually being driven by neck dysfunction.

A 2024 observational study published in Musculoskeletal Science and Practice found that individuals with a recent concussion history showed significantly worse cervical spine proprioception and more vestibular/oculomotor symptom provocation compared to those without concussion. Importantly, these deficits persisted even when other concussion symptoms had largely resolved.

This is why treating the neck is critical for resolving visual symptoms after concussion.

How We Treat Post-Concussion Visual Symptoms

Our approach addresses both the cervical spine and the visual system directly.

Chiropractic Care for the Cervical Spine

Gentle spinal mobilization and adjustments help restore normal joint movement in the upper cervical spine. This improves the quality of proprioceptive signals being sent to your brain, which in turn helps your visual system function more accurately.

A 2024 randomized controlled trial published in the Journal of Manipulative and Physiological Therapeutics found that patients who received chiropractic care showed improved gaze stability during the vestibulo-ocular reflex and better performance on the Stroop cognitive test compared to the control group. These findings suggest that some persistent visual and cognitive symptoms have a cervical spine component that responds to targeted treatment.

Vestibulo-Oculomotor Rehabilitation

Once cervical spine function begins to improve, we layer in specific exercises designed to retrain the visual system. These exercises are prescribed based on your specific deficits and gradually increase in difficulty as your system adapts.

Exercises That Help

Functional rehabilitation for post-concussion visual symptoms may include several types of targeted exercises.

Gaze stabilization exercises involve focusing on a fixed target while moving your head. This trains the vestibulo-ocular reflex to keep your vision stable during movement. These exercises are a cornerstone of vestibular rehabilitation and are supported by systematic review evidence for reducing symptoms after concussion.

Smooth pursuit training involves tracking a slowly moving target with your eyes while keeping your head still. This retrains the smooth pursuit system and reduces the jerky eye movements that make reading and tracking difficult.

Saccade training involves shifting your gaze quickly between two fixed targets. This improves the speed and accuracy of the rapid eye movements used during reading and scanning.

Near-far focus exercises involve alternating your focus between a close target and a distant target. This challenges your convergence system and helps reduce eye strain during close-up work.

Visual motion desensitization uses gradual, controlled exposure to visually complex environments to help your brain learn to process busy visual input without triggering symptoms. This is done progressively, starting with simple stimuli and building to real-world environments.

These exercises are prescribed individually based on your assessment findings. They’re designed to challenge your system just enough to promote adaptation without making your symptoms significantly worse.

When to Seek Care

If you’re dealing with eye strain that wasn’t there before the injury, difficulty reading or using screens that’s persisted beyond two weeks, headaches that build behind the eyes or get worse with visual tasks, light sensitivity that limits your daily activities, feeling overwhelmed or dizzy in busy visual environments, or double or blurred vision, it’s worth getting assessed.

Visual symptoms after concussion are treatable. The key is identifying whether the problem is being driven by the brain, the cervical spine, or both, and targeting treatment accordingly.

Evidence and Sources

1. Cade A, Turnbull D. Effect of chiropractic intervention on oculomotor and attentional visual outcomes in young adults with long-term mild traumatic brain injury: a randomized controlled trial. Journal of Manipulative and Physiological Therapeutics. 2024.
2. Langevin P et al. Cervical spine proprioception and vestibular/oculomotor function: an observational study comparing young adults with and without a concussion history. Musculoskeletal Science and Practice. 2024.
3. Ciuffreda KJ et al. Traumatic brain injury and vestibulo-ocular function: current challenges and future prospects. Eye and Brain. 2017.
4. Reneker JC et al. Sequencing and integration of cervical manual therapy and vestibulo-oculomotor therapy for concussion symptoms: retrospective analysis. International Journal of Sports Physical Therapy. 2021.
5. Murray DA et al. Effectiveness of vestibular rehabilitation after concussion: a systematic review of randomised controlled trials. Journal of Clinical Medicine. 2022.
6. Mucha A et al. A practical concussion physical examination toolbox: evidence-based physical examination for concussion. Current Sports Medicine Reports. 2014.