Why Concussion, Post-Concussion Syndrome, and Dysautonomia Cause Vision Problems

Vision involves much more than seeing clearly on an eye chart.

The brain must coordinate eye movement, focusing, balance, spatial awareness, attention, and the ability to interpret visual information. These systems work together constantly when we read, use a computer, drive, walk through a crowded store, exercise, or participate in sports.

Concussion, post-concussion syndrome, POTS, and other forms of dysautonomia can disrupt this coordination.

A person may have healthy eyes and normal visual acuity but still struggle to use vision comfortably and efficiently. Symptoms may include blurred vision, double vision, light sensitivity, difficulty reading, eye fatigue, headaches, dizziness, motion sensitivity, or trouble maintaining focus.

The problem is not always the eye itself. In many patients, the difficulty involves how the brain, eyes, vestibular system, cervical spine, and autonomic nervous system work together.

Vision Is a Brain Function

The eyes collect visual information, but the brain must organize and use that information.

To maintain clear and comfortable vision, the nervous system must coordinate:

• Eye alignment

• Near and distance focusing

• Rapid eye movements

• Tracking of moving objects

• Visual attention

• Balance and spatial orientation

• Head and eye movement

• Visual processing speed

• Autonomic regulation

• Integration of vision with movement

A concussion can disrupt these neurological pathways even when structural imaging and routine eye examinations are normal.

At NeuroSport, we often describe this as neurological visual pathway uncoupling.

The individual parts of the visual system may still function, but they no longer communicate or coordinate as efficiently as they did before the injury.

Common Vision Symptoms

Vision-related symptoms may be constant, or they may appear only when the visual system is challenged.

Patients may experience:

• Blurred vision

• Intermittent double vision

• Light sensitivity

• Eye strain or eye fatigue

• Headaches with reading or computer use

• Difficulty focusing from near to far

• Difficulty keeping words clear while reading

• Losing one’s place while reading

• Words appearing to move, jump, or blur

• Difficulty following moving objects

• Dizziness in visually busy environments

• Motion sensitivity

• Difficulty driving, especially at night

• Reduced visual endurance

• Problems judging distance or depth

• Increased symptoms in grocery stores, crowds, or scrolling environments

• Difficulty coordinating head and eye movement

• Problems returning to school, work, exercise, or sports

Some patients do not describe a specific problem with eyesight. Instead, they report feeling visually overwhelmed, mentally fatigued, dizzy, disoriented, or unable to tolerate busy environments.

How Common Is Visual Dysfunction After Concussion?

Visual symptoms are among the most common problems reported after concussion, especially in children, adolescents, and patients whose recovery is prolonged.

The American Academy of Pediatrics has reported that blurred vision, light sensitivity, and double vision occur in up to 40% of children and adolescents immediately after concussion.

The prevalence appears to be even higher among patients with persistent symptoms.

Research from specialty concussion clinics has reported:

• At least one associated vision disorder in approximately 69% of pediatric concussion patients

• Vision-related dysfunction in approximately 62.5% of children and adolescents with prolonged symptoms

• Vergence deficits in 62% of persistently symptomatic pediatric patients

• Accommodation deficits in 76% of persistently symptomatic pediatric patients

These findings matter because patients may not identify vision as their primary problem.

A child may report headaches, difficulty concentrating, reduced reading tolerance, or fatigue during school. An adult may report dizziness, brain fog, screen intolerance, or difficulty driving. In both cases, impaired eye coordination or focusing may be contributing to the symptoms.

Blurred vision and double vision are also reported in adults with persistent symptoms, although they are generally less frequent than headache, fatigue, and dizziness.

Even when visual symptoms are not the most severe complaint, they can still interfere with work, school, exercise, driving, and recovery.

Convergence Insufficiency

Convergence is the ability to move both eyes inward and maintain a single image when looking at something close.

Convergence insufficiency occurs when the eyes cannot consistently work together during near activities.

Symptoms may include:

• Double vision

• Blurred vision

• Eye strain

• Headaches

• Difficulty reading

• Losing one’s place

• Words appearing to move or separate

• Closing or covering one eye

• Avoidance of near work

Convergence insufficiency is frequently identified in patients with persistent symptoms following concussion.

A patient may still read the letters on an eye chart correctly while struggling to sustain binocular coordination during reading, computer work, or school activities.

Accommodative Insufficiency

Accommodation is the focusing mechanism that allows the eyes to maintain a clear image at different distances.

Accommodative insufficiency occurs when the focusing system cannot generate or sustain the effort required for near work.

Patients may experience:

• Blurred near vision

• Delayed focusing

• Difficulty shifting focus between near and far objects

• Eye fatigue

• Headaches

• Reduced reading endurance

• Difficulty using computers or mobile devices

This is particularly important for students and working adults who must repeatedly shift focus between a screen, keyboard, paper, or distant target.

A person may pass a distance-vision test and still have substantial accommodative dysfunction.

Saccadic Eye Movement Dysfunction

Saccades are the rapid eye movements used to shift visual attention from one target to another.

They are essential for:

• Reading

• Scanning a room

• Copying information

• Looking between a screen and keyboard

• Driving

• Sports participation

• Rapidly locating visual targets

After concussion, saccades may become slow, inaccurate, poorly coordinated, or symptom-provoking.

A patient may lose their place while reading, skip words, reread lines, struggle to copy information, or become increasingly symptomatic as visual demand continues.

These problems may be mistaken for reduced attention or poor concentration when the underlying difficulty is impaired eye movement control.

Smooth-Pursuit Dysfunction

Smooth pursuits allow the eyes to follow a moving object while keeping the image stable.

These eye movements are required when watching another person, following a ball, tracking traffic, viewing video, or observing movement in the environment.

Smooth-pursuit dysfunction may cause:

• Eye strain

• Dizziness

• Headache

• Nausea

• Difficulty tracking movement

• Motion sensitivity

• Problems following a ball or moving person

• Increased symptoms while watching television or video

Smooth-pursuit dysfunction may reflect impaired coordination among the visual, vestibular, attentional, and motor systems.

Vestibular-Ocular Dysfunction

The visual and vestibular systems must work together to keep images stable while the head and body move.

The vestibulo-ocular reflex allows the eyes to remain fixed on a target while the head is moving. When this system is disrupted, the visual world may appear unstable or difficult to process.

Patients may experience:

• Dizziness with head movement

• Blurred vision while walking

• Difficulty reading signs while moving

• Motion sensitivity

• Imbalance

• Nausea

• Disorientation in busy environments

• Difficulty riding in a vehicle

• Difficulty walking through stores or crowds

Patients sometimes describe this as feeling that their eyes, head, and body are no longer working together.

Light Sensitivity and Photophobia

Light sensitivity is common following concussion and may also occur with post-concussion syndrome, migraine, POTS, and other forms of dysautonomia.

Symptoms may be triggered by:

• Bright sunlight

• Fluorescent lighting

• Computer screens

• Mobile devices

• High-contrast patterns

• Rapidly changing light

• Driving at night

• Busy visual environments

Photophobia is not always caused by an eye disorder.

It may reflect increased sensitivity within neurological networks involved in visual processing, pain regulation, migraine, and autonomic function.

Research has also found reduced light-sensitivity thresholds in patients with POTS, suggesting that sensory network sensitization may contribute to photophobia in this population.

Why Dysautonomia Can Affect Vision

The autonomic nervous system helps regulate many functions that influence visual comfort and performance, including:

• Blood pressure

• Heart rate

• Pupil response

• Tear production

• Cerebral blood flow

• Arousal and alertness

• Tolerance for upright activity

• Response to physical and sensory stress

When autonomic regulation is impaired, patients may experience:

• Blurred vision while standing

• Visual dimming

• Tunnel vision

• Light sensitivity

• Difficulty focusing

• Eye pain or dryness

• Dizziness in visually stimulating environments

• Increased symptoms during prolonged upright activity

• Visual symptoms associated with presyncope

• Reduced tolerance for screens, reading, or busy environments

These symptoms may result from several overlapping mechanisms, including altered cerebral perfusion, migraine, sensory sensitization, pupillary dysfunction, small-fiber involvement, and abnormal autonomic regulation.

Some emerging research also suggests that patients with POTS may experience eye pain or dryness without the expected findings of conventional dry-eye disease. In some cases, altered corneal nerve function or neuropathic ocular pain may be involved.

When Concussion and Dysautonomia Occur Together

Concussion can disrupt both visual processing and autonomic regulation.

When post-concussion syndrome and dysautonomia occur together, patients may develop a more complicated pattern of symptoms involving:

• Vision

• Balance

• Heart-rate regulation

• Blood-pressure regulation

• Exercise intolerance

• Cognitive fatigue

• Headache

• Migraine

• Sleep disruption

• Motion sensitivity

Visual symptoms may worsen as the patient remains upright, becomes physically active, performs sustained near work, or moves through a visually demanding environment.

Reading, computer use, driving, grocery stores, crowds, and rapid head movement may all increase symptoms.

The visual system may also become increasingly symptomatic as heart rate rises or cognitive demand increases.

In these cases, treating only the eyes or only the autonomic nervous system may fail to address the full clinical picture.

A comprehensive evaluation is needed to determine which systems are contributing and how they are interacting.

The Neck Can Also Contribute

The cervical spine provides sensory information that helps the brain understand head position and movement.

A neck injury occurring with concussion may contribute to:

• Headache

• Dizziness

• Eye strain

• Motion sensitivity

• Difficulty stabilizing vision

• Symptoms with head movement

• Impaired balance

• Reduced coordination among the eyes, head, and body

The visual, vestibular, and cervical systems continually exchange information.

When cervical sensory input is distorted by pain, joint dysfunction, muscle injury, or altered movement, the brain may receive conflicting information about head position and motion.

This is one reason NeuroSport evaluates the cervical spine, visual system, vestibular system, and autonomic nervous system together when clinically appropriate.

Why a Routine Eye Examination May Be Normal

A standard eye examination remains important for identifying eye disease, visual acuity problems, refractive errors, and structural abnormalities.

However, many post-concussion vision problems involve how the brain controls and integrates vision rather than the physical health of the eye itself.

A patient may have:

• Normal visual acuity

• Healthy eyes

• A normal retinal examination

• An updated glasses prescription

and still have difficulty with:

• Convergence

• Accommodation

• Saccades

• Smooth pursuits

• Vestibular-ocular coordination

• Visual motion processing

• Visual endurance

• Neurological visual integration

A normal structural eye examination does not exclude a concussion-related functional vision disorder.

Why Visual Dysfunction Is Often Missed

Visual dysfunction may not be recognized when the examination focuses only on visual acuity or eye structure.

Patients may also describe their symptoms indirectly.

Instead of reporting blurred or double vision, they may complain of:

• Headaches

• Dizziness

• Fatigue

• Reduced concentration

• Motion sensitivity

• Difficulty reading

• Screen intolerance

• Feeling overwhelmed in busy environments

Children may avoid reading or homework, lose their place, develop headaches during class, or appear inattentive.

Adults may struggle with computer work, driving, visual multitasking, or maintaining productivity throughout the day.

Without specific testing of convergence, accommodation, saccades, smooth pursuits, gaze stability, and vestibular-ocular function, the visual component may remain unidentified.

The NeuroSport Vision Evaluation

At NeuroSport Spine & Concussion Center, vision is evaluated as part of a broader neurological, vestibular, autonomic, and musculoskeletal examination.

The goal is not simply to confirm that symptoms exist.

The goal is to identify which systems are not working together correctly and what factors may be preventing recovery.

Depending on the patient’s presentation, the evaluation may include:

• Visual symptom history

• Cranial nerve screening

• Pupillary responses

• Visual fields

• Ocular alignment

• Near point of convergence

• Accommodation

• Smooth-pursuit testing

• Saccadic eye movements

• Gaze stability

• Vestibular-ocular reflex testing

• Visual motion sensitivity

• Eye-head coordination

• Cervical contribution to symptoms

• Balance and postural control

• Autonomic testing

• Symptom response to cognitive and physical activity

This broader approach helps distinguish between an eye-health problem and a neurological coordination problem.

It also helps determine whether treatment can be managed at NeuroSport or whether referral to an optometrist, neuro-optometrist, ophthalmologist, neuro-ophthalmologist, neurologist, or vestibular specialist is appropriate.

Evidence-Guided Rehabilitation

There is no single exercise or treatment that is appropriate for every patient with visual symptoms.

Care should be based on the specific dysfunction identified during the examination and the patient’s tolerance.

Treatment may include:

• Graduated ocular-motor rehabilitation

• Convergence exercises

• Accommodation exercises

• Saccadic retraining

• Smooth-pursuit retraining

• Gaze-stability exercises

• Visual-motion desensitization

• Vestibular rehabilitation

• Cervical spine treatment

• Balance rehabilitation

• Autonomic rehabilitation

• Graduated cardiovascular exercise

• Return-to-learn accommodations

• Workplace modifications

• Activity pacing

• Referral for specialty vision care

Exercises must be appropriately dosed.

Excessive visual loading can aggravate headache, dizziness, nausea, fatigue, and autonomic symptoms. Rehabilitation should challenge the visual system without causing a prolonged increase in symptoms.

More is not always better. The correct stimulus, applied at the correct level, is what matters.

When Referral Is Needed

NeuroSport evaluates vision-related symptoms routinely and refers patients when additional specialty examination or treatment is indicated.

Referral may be appropriate when there is concern for:

• Eye injury

• Visual-field loss

• Persistent or worsening double vision

• Cranial nerve dysfunction

• Strabismus

• Retinal or optic-nerve disease

• Significant refractive change

• Persistent convergence or accommodative dysfunction

• Complex binocular vision disorders

• Neuro-ophthalmic disease

• Need for prism, lenses, or specialty optical treatment

• Symptoms that do not respond as expected

Collaboration may involve ophthalmology, neuro-ophthalmology, optometry, neuro-optometry, neurology, vestibular rehabilitation, or other specialists depending on the findings.

The purpose of referral is not to separate vision from the rest of the patient’s condition. It is to build the right care team around the patient.

Warning Signs Requiring Urgent Evaluation

Seek urgent medical evaluation for:

• Sudden loss of vision

• A new visual-field deficit

• Persistent or rapidly worsening double vision

• Unequal pupils

• Severe eye pain

• New eyelid drooping

• New weakness or numbness

• Slurred speech

• Increasing confusion

• Repeated vomiting

• Worsening severe headache

• Seizure

• Loss of consciousness

• Sudden neurological deterioration

These symptoms should not be assumed to be part of routine concussion recovery.

Vision Problems Can Affect the Entire Recovery

Vision is involved in nearly every waking activity.

When visual function is impaired, patients may struggle with school, work, exercise, driving, reading, balance, social environments, and everyday movement.

Visual dysfunction may also amplify headache, dizziness, cognitive fatigue, neck tension, motion sensitivity, and autonomic symptoms.

Identifying the visual component of concussion, post-concussion syndrome, or dysautonomia can provide an important missing piece of the recovery process.

Schedule a NeuroSport Evaluation

Persistent blurred vision, double vision, light sensitivity, reading difficulty, eye fatigue, dizziness, or motion sensitivity should not be dismissed simply because an eye examination or brain scan was normal.

NeuroSport Spine & Concussion Center evaluates how the visual, vestibular, autonomic, cervical, and neurological systems function together.

A detailed evaluation can help determine:

• What is contributing to the symptoms

• Which systems require rehabilitation

• Whether visual symptoms are linked to concussion, dysautonomia, cervical dysfunction, or another condition

• Whether referral to an eye or vision specialist is appropriate

• How care can support return to school, work, driving, exercise, and sport

Schedule a NeuroSport Evaluation

Further Reading

Vision and Concussion: Symptoms, Signs, Evaluation, and Treatment
American Academy of Pediatrics, Pediatrics, 2022.

Evaluation of the Visual System by the Primary Care Provider Following Concussion
American Academy of Pediatrics, Pediatrics, 2022.

Post-Concussion Clinical Findings of Oculomotor Function in Paediatric Patients With Persisting Symptoms Compared With Healthy Controls
Roberts L, et al. Ophthalmic and Physiological Optics, 2025.

Synergistic but Separable Sensory Changes in Postural Tachycardia Syndrome and Chronic Migraine
Cortez MM, Millsap L, Brennan KC. Clinical Autonomic Research, 2021.

Relating Brain Function to Cognitive-Visuomotor Integration Performance in Working-Aged Adults With Persisting Concussion Symptoms
Ozzoude ME, et al. Frontiers in Human Neuroscience, 2026.