Post Traumatic Vision Syndrome
Post traumatic vision Syndrome occur after a traumatic brain injury(TBI) or Cerebrovascular insult or a neurovascular incident( Cerebral palsy, multiple sclerosis, concussion whiplash). Inherent Visual processing mechanisms are affected causing altered ability to comprehend and process visual and sensory feedback causing dysfunction in vision. Following a neurological insult various symptoms related to vision like headaches, diplopia, vertigo, asthenopia, photophobia, inability to focus and track on objects.
Clinical signs and symptoms- Binocular vision and accommodative disturbances in vision are common after mTBI. Oculomotor deficits in accommodative and binocular vision dysfunctions may occur from damage to the cranial nerves( Oculomotor, trochlear and abducens nerve). Exotropia and Exophoria are common after a neurological event. There are also difficulty in convergence and difficulty in accommodation and increased myopia (Blurred near vision). Patient also suffer from oculomotor dysfunction leading to vision problems. Patient report to have symptoms like double vision(Diplopia)Dizziness, Nausea, eye Strain(asthenopia), Sensitivity to light(Photophobia) and perceived movement of print or stationary Objects[1].
In addition to visual motor function there could be balance and posture can be affected as there can be midline shift. In Case of Homonymous hemianopsia(Loss of Vision on one side) there is a midline shift affecting Balance and posture leading to instability and frequent falls. Due to visual mismatch and processing errors patient report vertigo, dizziness, and balance problems.
Outcome measures- SCAT-3, VOMS, Dizziness handicap inventory (DHI)
24 hour Patterns - Better in morning. Worse with activity and in busy environment. Symptoms are worse by the end of the day in evening. Sleep disturbances are also noticed.
Testing-
Cranial nerve testing – motor weakness in Cranial nerve 3, 4, or 6 may be contributing to diplopia, or vertical imbalances
Most commonly patients with PTVS experience difficulties with eye tracking, eye teaming/convergence, and eye focusing problems, which may be noticed using the following tests:
Single and double Maddox rod testing.
Nuclear eye movements (Ductions).
Supranuclear eye movements – versions, pursuits, saccades, convergence, vestibulo-occular reflex.
Visual field testing – can give information on what type of loss if any the patient is experiencing
Visual Acuity at 10 feet – using letters and shapes – can help indicate possible neglect or field of vision loss
Red Desaturation Test – Rule out ocular nerve damage
Special tests- Visual inattention/ neglect testing – often present with PTVS from a TBI.
Aneisokonia testing – may show discrepancies in object size between eyes
Hirschberg test & Cover Test: test for ocular alignment
Referrals- referral to optometrist to investigate if prism lenses are indicated.
Original Editor - User Name
Top Contributors - Yagdutt Yagdutt, Kim Jackson, Nupur Smit Shah and Carina Therese Magtibay
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- ↑ Padula W V., Capo-Aponte JE, Padula W V., Singman EL, Jenness J. The consequence of spatial visual processing dysfunction caused by traumatic brain injury (TBI). Brain Inj [Internet]. 2017;31(5):589–600. Available from: https://doi.org/10.1080/02699052.2017.1291991
