Management of post-concussion eye symptoms

Why do they happen?

In short, a concussion causes brain cells to be temporarily damaged.  Thankfully, these brain cells will heal!  Until they heal, communication between brain cells is more difficult.  This difficulty results in concussion symptoms because the brain is having to work harder, with injured connections and less energy, trying to perform its usual numerous actions.   This very helpful blog post explains exactly what happens in the brain that causes eye symptoms: What happens to your brain?

How else could this symptom manifest?

• When reading, loosing his/her place on a page
• Experiencing blurry or double vision
• Headaches
• Difficulty concentrating and remembering content
• Very fatigued by end of day

Are there any helpful medications/supplements?

“Fortunately, your brain can repair and heal itself! It is valuable to remember that your brain can be retrained. Networks between neurons can be reshaped, rebuilt, and strengthened.”  With time, care, and occasionally with medications and natural health products, quality of life and symptoms will get better.  Though this list is not extensive, these are a few medications/supplements to discuss with your concussion provider that may be helpful for your child’s eye symptoms:

• Omega-3’s (while not targeted to a specific symptom, helpful in overall concussion recovery)
• Multivitamin (If lacking a well-balanced diet, a daily multivitamin is important since good nutrition is essential for healing. Also, it’s important to have adequate Vitamin D levels at baseline as Vitamin D deficiency can lead to prolonged recovery - More info on Vitamin D. )

The FDA does not regulate Natural Health Products (NHP’s) in the same way as prescription medications and therefore when choosing a NHP it is important to consider interactions with other NHP’s and medications, whether the product has undergone 3rd party testing (like that done by Consumer Lab), and the number of ingredients in each product.   The companies we typically trust, because they conduct 3rd party testing and have fewer added ingredients include:  Metagenics, Pure Encapsulations, Nordic Naturals, Barleans, Kirkland Signature, NatureMade, and Neurobiologix. 

What else can we do?

1. Encourage your child to listen to his/her body. If an activity he/she is doing is not making the eye symptoms worse, it is likely okay to continue (assuming the activity has no risk for another brain injury).  If the eye symptoms are worsened by an activity, it is best to stop, take a break, and then try again.  Listening to his/her body, rather than “pushing through” an activity despite worsening symptoms, will greatly help recovery.  An easy rule of thumb is not let their eye symptoms reach a number >5/10.  So, if for example they start their day with light sensitivity rated 2/10 and being in the bright classroom lights causes it to go up to a 4/10, it’s okay to keep pushing; however, if that light sensitivity reaches to a 5 or greater, stop and take a break. 
2. Wear a ball cap or sunglasses in school and in the car to diminish light sensitivity from fluorescent lights at school and from sunlight outside.
3. For screens causing eye strain, try turning the phone on “night shift” to decrease screen brightness. Tinted transparencies may help when looking at computer screens and lights. Gray tints help with all over light sensitivity. Rose tints help with fluorescent lights, LED lights, and computer screens.  Amber tints help improve contrast sensitivity. Blue tints help block low wavelength light.  These can be found on Amazon.com by searching “colored overlays for reading or dyslexia.”
4. For those experiencing eye symptoms when reading, such as blurry vision or loosing place on a page, this may be due to something called convergence insufficiency. This condition is not uncommon after a concussion and resolves with time.  Try using a sheet of paper on the page to rest under the line he/she is reading and to cover all the other words further down the page; move the paper down line by line as he/she reads down the page.  It may also be helpful to have a parent read the content out loud or listen to content on an audiobook.  A referral to a concussion trained physical therapist is often the best course of action for convergence insufficiency; they have great techniques to help alleviate this condition and the symptoms it causes.
5. Though parents know our children so well, we can’t read their minds. To complicate things, their concussion symptoms are often not obvious us, unless they are specifically verbalized outload.  Because of this, it can be easy to doubt that they truly feel the symptoms they are reporting.  It is so important that we validate them, letting them know that that we believe them. Then, it is important to encourage them that these concussion symptoms will resolve and that they will return to normal.

Most children recover from a concussion in 3-4 weeks, and during that time, symptoms typically improve very gradually.  If this is not the observed trend, or symptoms are worsening, it is very important to talk to your concussion provider. 

References:

https://www.cdc.gov/traumaticbraininjury/pdf/pediatricmtbiguidelineeducationaltools/2018-mTBI_Recovery-508.pdf

https://www.concussionalliance.org/what-happens-to-your-brain