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Photophobia or photosensitivity, is one of the more common conditions associated with a traumatic brain injury, experienced by approximately 50% of patients.
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One of the most common symptoms reported after a head injury is photophobia or light sensitivity. This is experienced both by those who have had a serious head injury (TBI or traumatic brain injury) as well as a mild head injury (mTBI).
Mild TBI (mTBI), which is typically defined by Glasgow Coma Scale score ≥ 13, accounts for the vast majority of all TBIs, particularly in the setting of sports-related injuries. The Glasgow Coma Score is a method for assessing the patient's extent of consciousness after a traumatic brain injury.
At our specialty eye care center we provide advanced care for patients who experience light sensitivity following a stroke, concussion or neurological condition. We are proud to provide cutting edge neuro optometric rehabilitation services to patients from all over Tennessee, and we are proud to be a leading provider of neuro-optometric rehabilitation services for patients from Hixson, Chattanooga, Cleveland, and Middle Valley.
A mTBI can result in a variety of visual complications. These are some of the most common visual-related conditions and symptoms:
The conditions described above are in some way related to one another. There is a link between convergence problems and accommodative problems, for example. Another example is headaches and photophobia. Post Traumatic Vision Syndrome was described by William V. Padula, OD, as a cluster of vision and spatial disorders that affect people who have suffered a neurological event, such as a traumatic brain injury, a cerebral vascular accident, multiple sclerosis, or another neurological disorder.
If you are experiencing any of the above symptoms and conditions following a traumatic brain injury, you don't have to suffer any longer. It is possible to alleviate these symptoms with a customized neuro-optometric rehabilitation plan and continue to do your everyday tasks without difficulty and sensitivity to light. To schedule a neuro-optometric evaluation, please call (423) 710 3965.
Often, when the visual system isn't functioning appropriately after a neurological/traumatic injury, we see a high level of exophoria (one eye drifting out) or exotropia (eye misalignment where one eye deviates outwards). Due to this additional effort, the visual system is stressed and activates the proprioceptive fibers in the extraocular muscles, which transmit signals to the trigeminal ganglion indicating the added effort. Nerve signals sent to the trigeminal ganglion activates pain signals through the thalamus and up to the cerebral cortex. Patients may experience headaches, light sensitivity, or dizziness.
Photophobia is closely linked to pain sensation. It is the trigeminal nerve and its nuclei that are responsible for sensations of pain in the head. Several parts of the eye are densely innervated with trigeminal fibers and sensitive to pain, including the conjunctiva, cornea, sclera, and uvea (iris, ciliary body, and choroid). Photophobia is usually caused by painful stimuli to these areas (e.g. corneal abrasion, iritis, uveitis).
On a pathophysiological level, let's examine some of the more common mechanisms. The retina contains photosensitive cells known as rods, cones, and intrinsic photosensitive retinal ganglion cells (ipRGCs). In the human retina, rods and cones are the predominant photosensitive cells. Melanopsin is found in the intrinsic photosensitive retinal ganglion cells. These cells specifically detect luminance levels, but they do not support vision. The ipRGC sends axons to the suprachiasmatic nucleus of the hypothalamus, and these axons control circadian rhythms. In addition, the ipRGC cells also send axons to the Edinger-Westphal nucleus to control the pupil light reflex. In the human retina, there are only 3,000 of these cells, representing .2% of all RGCs. These cells are photoreceptive, with maximum sensitivity to blue light within the 460-480 nm range. A patient with a traumatic brain injury may have a poorly regulated melanopsin-signaling system when exposed to light.
In patients with photosensitivity, visual fields are important. It was noted by Christine T. Langerhorst and Avinoam B. Safran that there were generalized constrictions in the visual field. While the authors attributed it to an attention disorder, Jackowski attributed it to loss of rod-mediated activity related to dark adaptation. All patients reporting photosensitivity had visual field losses within the central 30 degrees when Jackowski used frequency doubling technology (FDT). Rods affect magnocellular loss, which affects the FDT. These patients reported collapsing visual fields during testing. Kinetic fields, such as Octopus or Goldmann, can also be used to map the visual field constriction. It was found that the FDT and kinetic fields show a strong correlation with visual field constriction.
The degree of light sensitivity caused by mTBI varies from mild to severe. The most severe cases might require patients to wear sunglasses constantly, even indoors. They may be sensitive to fluorescent lighting as well as digital devices, which emit a lot of blue light. With the introduction of filters and vision rehabilitation, light sensitivity can be improved even when it is severe and of long duration.
The goal is to relieve symptoms with specific filters and to take the patient off the use of sunglasses indoors. Photosensitivity is associated with visual fatigue. It often occurs in conjunction with binocular vision problems, and is not a standalone condition. Binasal occlusion is used to reduce binocular stress in patients with mTBI. Through binasals, the system becomes less hyper-focused, which reduces sensitivity to light. Additionally, blue filters may reduce symptoms of indoor light sensitivity. Polaroid, blue-blocking filters, and FL-41 filters can be used outdoors to tone down the brightness.
Photophobia is a complex subject. Research in the future will provide us with a deeper understanding of photophobia in mTBI patients and allow us to provide better treatment for them.
If you don’t already have a trusted optometrist or you live too far from our optometry clinic in Hixson, you could start your online search by typing in phrases such as "eye doctor near me," "optometrist near me," or "eye specialist near me."
If you or a loved one has suffered a traumatic brain injury and has been suffering from light sensitivity or any of the above listed visual conditions, please schedule a neuro-optometric evaluation with Dr. McBryar.
Dr. McBryar runs a specialty optometry practice, Amplify EyeCare Chattanooga, located in Hixson, Tennessee. Dr. McBryar specializes in the fields of developmental optometry, working with children and special needs to realize their full potential. She has many achievements in her field:
To schedule a neuro optometric evaluation, please call (423) 710 3965. Those who have suffered a traumatic brain injury and have been suffering from visual conditions visit our clinic from all over Tennessee, and we are proud to be a leading provider of neuro-optometric rehabilitation services for patients from Hixson, Chattanooga, Cleveland, and Middle Valley.
Vision therapy is well worth the response, time and effort. Our Son had a hard time focusing and writing neatly. After vision therapy Seth could complete a task in half the time if previously took. His abilities to focus improved greatly and so did his handwriting.
Also, he was better at listening. As a parent, we wanted learning to be fun for our Son, and vision therapy made this possible.
Vision Therapy is well worth the expense, time and effort. Our son had a hard time focusing handwriting neatly. After vision therapy Seth could complete a task in half the time it previously took his abilities to focus and improved greatly and so did his handwriting.
Also, he was better at listening. As a parent you wanted learning to be fun for our son and vision therapy made this possible.
Vision Therapy has given or son the tools he needs to be able to scan and read the written word more effectively and efficiently.
He love working with John and these working sessions give him the motivation to gladly work on his homework assignments.
It amazed us to see the difference in the tracking of his eyes and along a line of it's from the beginning to the end of the treatment.
Dr. McBryar , Kristen and John are all marvelous and we would recommend them to anyone I only wish that we would have found them sooner!
Prior to coming to the institute for vision development my son complained of daily headaches. Therapy has eliminated his headaches completely. I love knowing my son is able to learn pain-free for the rest of his life because of the work that has been done over just a few weeks in this office. He he absolutely loved coming that didn't even feel like going to a doctor or therapy. We are grateful for the relief he was able to find by coming here.
Thank you!
Seems much less frustrated with life
Reads non-stop and fast
Spelling abilities have been hugely improved
Seems much more confident
Thank You!!!
When we first came to the practice, my son did not have huge issues, but lots of small ones- trouble with reading, sports (hitting the baseball consistently), coordination, etc- that were not easily detectable,but when put together presented issues. The staff here were all very professional and loving towards him. While I was concerned in the reading, my son was concerned with the athletic side. Seeing improvement night off the bat gave him confidence that i have nor seen in him and made him want to not only Come to therapy, but also made him want to work hard. He has surpassed his grade level and above in reading and hit his first home run this year! Thank you!!!
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