Why reading, computer screens, and visually busy environments can become difficult—and when a specialized eye examination may help.
By Myrna Cardiel, MD | Cardiel Precision Brain Health
After a concussion, patients often expect headaches, dizziness, or fatigue. What may surprise them is how difficult ordinary visual activities can become.
Someone who previously spent hours comfortably working on a computer may suddenly struggle to tolerate 30 minutes of screen time. Reading a book may trigger a headache. Scrolling through a smartphone can produce nausea or dizziness. Walking through a crowded supermarket may feel overwhelming.
Some patients describe their vision as blurry or unstable. Others report difficulty focusing, losing their place while reading, or feeling mentally exhausted after tasks that previously required little effort.
These experiences can be particularly frustrating when routine eye testing is reassuring and brain imaging reveals no significant abnormalities.
Yet visual complaints after concussion are well recognized. Understanding their possible causes can be an important part of guiding recovery.
The Brain Does More Than Simply See
Vision involves much more than the ability to identify letters on an eye chart.
To read comfortably, navigate an environment, or follow moving objects, the brain must continuously coordinate several complex functions.
The eyes must move together, maintain accurate alignment, shift attention between targets, adjust focus for different distances, and remain stable while the head is moving.
A concussion can temporarily disrupt aspects of these systems, sometimes contributing to symptoms that affect daily functioning.
Importantly, having 20/20 visual acuity does not necessarily mean that all aspects of visual coordination and processing are functioning normally.
Which Visual Problems Can Occur After Concussion?
Convergence insufficiency
Convergence refers to the ability of both eyes to turn inward together when focusing on a nearby object, such as a book or computer screen.
When convergence is insufficient, patients may experience eye strain, intermittent double vision, headaches, or difficulty sustaining near work.
Reading may become especially uncomfortable. Some patients report that words appear to move or that they repeatedly lose their place on a page.
Accommodative dysfunction
Accommodation allows the eye to adjust its focus when looking between near and distant objects.
Following concussion, some individuals experience difficulty sustaining near focus or shifting focus efficiently.
This may cause intermittent blurring, eye fatigue, headaches, and difficulty performing prolonged computer work.
Abnormalities in eye movement control
Two important types of eye movements are saccades, which rapidly shift gaze between targets, and smooth pursuits, which allow the eyes to follow moving objects.
Symptoms may be provoked when these systems are tested following concussion.
However, symptom provocation alone does not establish a specific ocular motor disorder. Headache, fatigue, attention, and vestibular dysfunction can influence performance, making careful clinical interpretation essential.
Visual motion sensitivity
For some patients, the greatest difficulty is not reading but navigating a moving visual environment.
Scrolling text, passing traffic, crowded streets, escalators, or supermarket aisles may provoke dizziness, nausea, imbalance, or headaches.
These symptoms reflect the complex interactions between visual information, vestibular processing, and the brain's interpretation of movement.
They may overlap with vestibular migraine or, in selected patients with persistent symptoms, persistent postural-perceptual dizziness (PPPD).
Not every patient with visual motion sensitivity has an identifiable eye movement abnormality.
When Should a Neuro-Ophthalmologist Be Involved?
An important part of post-concussion care is recognizing when symptoms warrant evaluation beyond a routine vision screening.
Neuro-ophthalmology is a subspecialty that focuses on disorders affecting the connections between the eyes, brain, visual pathways, and eye movement systems.
A neuro-ophthalmologist may perform a detailed assessment of ocular alignment, eye movements, binocular function, pupils, optic nerves, and visual fields, selecting additional testing when clinically appropriate.
This expertise can be particularly helpful when patients experience persistent double vision, suspected ocular misalignment, abnormal eye movements, unexplained visual loss, or other concerning neurological visual findings.
The purpose is not simply to identify concussion-related dysfunction. It is also to distinguish these symptoms from other neurological or ophthalmological conditions that may require a different approach.
Not every patient recovering from concussion needs a neuro-ophthalmology consultation. Some visual concerns can be evaluated by appropriately trained ophthalmologists or optometrists, while others may primarily require neurological or vestibular assessment.
The appropriate referral depends on the symptoms and examination findings.
New double vision, sudden visual loss, or other acute neurological abnormalities following head trauma require urgent medical assessment rather than routine outpatient referral.
What Does the Research Tell Us About Treatment?
Fortunately, many visual symptoms improve as patients recover from concussion.
For those with persistent problems, however, targeted interventions may be useful when a specific deficit has been established.
Research in this area has evolved.
A randomized clinical trial known as CONCUSS, published in the British Journal of Sports Medicine in 2026, examined office-based vergence/accommodative therapy in patients aged 11–25 years with persistent symptoms and confirmed concussion-related convergence insufficiency.
Participants receiving structured therapy demonstrated significantly greater improvement in convergence measures and symptoms than those whose treatment was initially delayed.
A subsequent 2026 analysis also demonstrated improvements in accommodative function.
These findings are encouraging, but they should be interpreted within the population and conditions studied. They do not establish that every patient experiencing headaches, dizziness, or visual discomfort after concussion requires vision therapy.
Treatment should follow a careful examination and an individualized diagnosis. Depending on the clinical findings, management may involve visual task modifications, selected vision rehabilitation, vestibular physical therapy, treatment of post-traumatic headache or migraine, and coordinated specialty care.
Why Visual Symptoms Can Feel Like Cognitive Problems
One of the more interesting aspects of concussion recovery is the relationship between visual function and cognitive performance.
Reading, concentrating, processing information, and working on a computer all depend on coordinated visual and cognitive activity.
When these tasks provoke headaches, dizziness, blurred vision, or excessive visual effort, patients may understandably describe themselves as unable to concentrate or think clearly.
This does not mean that every cognitive complaint after concussion is caused by visual dysfunction. Sleep disturbances, migraine, pain, fatigue, mood symptoms, and the direct effects of concussion may also contribute.
Nevertheless, recognizing visual problems can help explain why seemingly simple activities have become unexpectedly difficult.
A More Individualized Approach to Recovery
In my neurological practice, I believe that recovery planning should begin with understanding the particular symptoms limiting each patient's return to normal activities.
For one individual, persistent migraine-like headaches may be the main obstacle.
For another, vestibular symptoms or neck-related pain may dominate.
For someone else, visual discomfort, difficulty reading, or intolerance of computer work may be preventing a return to professional responsibilities.
A detailed neurological evaluation can help distinguish these possibilities and determine which additional assessments or treatments may be useful.
When appropriate, collaboration with neuro-ophthalmologists, ophthalmologists, optometrists, and vestibular rehabilitation professionals can be an important part of that process.
The objective is not to pursue every available test or therapy. It is to identify the contributing problems and develop an evidence-informed plan for recovery.
Specialized Neurological Evaluation in New York City
At Cardiel Precision Brain Health, I provide personalized neurological evaluations for adults experiencing headaches, dizziness, visual sensitivity, and other neurological symptoms following concussion.
My approach emphasizes extended consultations, careful clinical assessment, individualized recovery planning, and coordination with other specialists when appropriate.
Patients experiencing persistent symptoms after a recent concussion, as well as physicians seeking a neurological consultation for their patients, are welcome to inquire about availability.
Consultations take place in Midtown Manhattan, with appointment requests reviewed individually according to clinical needs and appropriateness.
Request a private consultation or book a focused visit online through Cardiel Precision Brain Health.
Selected References
Master CL, et al. Vision and Concussion: Symptoms, Signs, Evaluation, and Treatment. Pediatrics. 2022;150(2). https://doi.org/10.1542/peds.2021-056047
Subramanian PS, et al. Consensus Statement on Visual Rehabilitation in Mild Traumatic Brain Injury. Neurology: Clinical Practice. 2022;12(6):422–428. https://doi.org/10.1212/CPJ.0000000000200071
Alvarez TL, et al. CONCUSS Randomised Clinical Trial of Vergence/Accommodative Therapy for Concussion-Related Symptomatic Convergence Insufficiency. British Journal of Sports Medicine. 2026;60(5):340–354. https://doi.org/10.1136/bjsports-2025-109807
Scheiman M, et al. Effectiveness of Office-Based Vergence/Accommodative Therapy with Movement for Accommodative Dysfunction in Concussion-Related Convergence Insufficiency. British Journal of Sports Medicine. 2026;60(19):1475–1485. https://doi.org/10.1136/bjsports-2025-111200
This article is intended for educational purposes and does not replace individualized medical evaluation.
