Vision and Concussion: Symptoms, Signs, Evaluation, and Treatment

Publication Date: July 18, 2022
Last Updated: July 19, 2022

Summary of Recommendations

Clinicians should consider screening for vision problems after concussion in children and adolescents to determine potential academic and activity modifications after injury.


Visio-vestibular Examination After a Suspected Concussion

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Test Description
Pursuit eye movements Pursuit is examined by holding a near visual stimulus at 1–2 feet from the patient. Move the stimulus back and forth in a slow and steady fashion, horizontally about 160 degrees (from patient’s ear to ear) and vertically about 120 degrees (from patient’s forehead to chin).Both eyes should follow the stimulus symmetrically and smoothly.
Saccadic eye movements Saccades are tested with 2 near stimuli as above, 1 in each hand.Hold them about 2 feet apart, 1–2 feet in front of the patient, horizontally then vertically.Ask the patient to refixate between the 2 stimuli on your command several times horizontally then vertically.The eyes should move quickly and symmetrically and end accurately on the stimulus.
VOR VOR is examined while holding the stimulus at 1–2 feet directly in front of the nose. The patient rotates his or her head horizontally for about 160 degrees (shaking head from side to side) and then vertically for about 120 degrees (nodding head up and down).The eyes should remain on the near stimulus throughout the head movement.
Near point of convergence Convergence testing is accomplished by holding a visual stimulus about 2 feet in front of the patient and bringing the stimulus toward the face until the eyes stop converging.The eyes should continue to converge on the stimulus until about 6 cm (∼2 in.) from the forehead.
Accommodative amplitude Accommodation testing is performed monocularly using a standard reading card.After patching one eye, ask the patient to fixate on the smallest readable letter at about 2 feet away, move the card toward the eye until the patient reports blurring of that same letter, then measure that distance in centimeters.Most children will be able to see the letter clearly until 10 cm (∼4 in.) from the eye.
Strabismus While the patient fixates on a distant target, the monocular cover-uncover test is performed by covering and uncovering each eye (right eye, then left eye), with the examiner watching carefully for any movement in the opposite, noncovered eye; such movement indicates the possible presence of strabismus.



Vision and Concussion: Symptoms, Signs, Evaluation, and Treatment

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