Understanding photophobia in mTBI patients

Photophobia or photosensitivity, is one of the more common conditions associated with a traumatic brain injury, experienced by approximately 50% of patients.

Understanding photophobia in mTBI patients in Manhattan

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 New York, and we are proud to be a leading provider of neuro-optometric rehabilitation services for patients from New York, Queens, Brooklyn, and Long Island.

Amplify EyeCare Manhattan

What are the most common symptoms and conditions you may experience following a mTBI?

A mTBI can result in a variety of visual complications. These are some of the most common visual-related conditions and symptoms:

  • Oculomotor dysfunction
  • Convergence insufficiency
  • Accommodative dysfunction
  • Dry eye
  • Photophobia
  • Visuo-spatial disorientation
  • Dizziness
  • Headache
  • Sleep disorders
  • Photophobia, or photosensitivity, is one of the more common conditions associated with TBI, experienced by approximately 50% of patients.
  • The reduced peripheral field (also known as collapsed fields) is another common mTBI symptom.

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 (212) 752-6930.

How does a TBI affect your visual ability?

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.

How does a TBI affect your visual ability?
What is the connection between light sensitivity and traumatic brain injuries?

What is the connection between light sensitivity and traumatic brain injuries?

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).

What is the connection between light sensitivity and traumatic brain injuries?

What is the mechanism that triggers light sensitivity in TBI?

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.

Does visual field loss occur in patients with light sensitivity?

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.

How does a TBI affect your visual ability?
What is the connection between light sensitivity and traumatic brain injuries?

How is light sensitivity treated and managed in patients with mTBI?

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.

Common Questions

In some cases, photophobia may be temporary and resolve on its own or with treatment. In other cases, it may be a long-term or permanent condition. Since there are a variety of causes for light sensitivity it is very important to schedule a neuro optometric evaluation to fully understand what is causing your symptoms.
Some people find relief from photophobia with home remedies such as using artificial tears, wearing sunglasses or a hat to block out bright light, or taking breaks from screens and other sources of artificial light. However in most cases these home remedies are not adequate to solve the issue. When you schedule a neuro optometric evaluation we spend time assessing the root cause of your light sensitivity as well as discussing the various treatment options such as binasal glasses and specialized filters. It is important to note that home remedies are generally not effective for everyone and are not a substitute for proper medical treatment by an eye doctor.
If you are experiencing photophobia and it is severe, persistent, or causing discomfort, it is important to see a neuro optometrist. You should also see a neuro optometrist if you are experiencing other symptoms that may be related to an underlying condition, such as eye pain or changes in vision. In many cases light sensitivity can be remedied by using filtered lenses or binasal glasses, these is a fairly simple solution and does not require a major investment, we highly recommend scheduling a neuro optometric evaluation to treat your light sensitivity.
Understanding photophobia in mTBI patients
Dr. Wernick cartoon

Schedule a neuro optometric evaluation near you

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. Wernick.

Dr. Nathaniel (Nat) Wernick, FCOVD, graduated from the Northeastern State University College of Optometry and was selected for Residency training at the State University of New York (SUNY) College of Optometry. As a Resident Optometrist, he specialized in Pediatrics, Vision Therapy, and Traumatic Brain Injury. He has advanced training in developmental optometry and is a Fellow of the College of Optometrists in Vision Development (FCOVD).

Patients visiting Dr. Wernick will receive an in depth examination that extends beyond a comprehensive eye examination with a detailed look at ocular health, vision, contact lens fitting, prescription for eyewear, as well as developmental vision to screen for teaming skills, binocular vision, and visual processing. Dr. Wernick provides full-scope care to patients of all ages including diagnosis and treatment of conditions including red eyes, eye allergies, diabetic and hypertensive eye checks, glaucoma, macular degeneration, dry eyes, eye strain/headaches, and cataracts. Dr. Wernick's advanced training in developmental vision, makes him a sought after provider for pediatric patients, special needs, post concussion, post stroke and sports vision.

To schedule a neuro optometric evaluation, please call (212) 752-6930. Those who have suffered a traumatic brain injury and have been suffering from visual conditions visit our clinic from all over New York, and we are proud to be a leading provider of neuro-optometric rehabilitation services for patients from New York, Queens, Brooklyn, and Long Island.

Related Articles

Testimonials


At Amplify with Dr Wernick I was seeking help for seemingly intractable, probably age-related dryness. I've seen other doctors about it, and that has been helpful, but what he explained to me about it and the careful way he answered all my questions gave me so much more of a clear understanding of what is going on (and is not) that I am more able to implement all his and others' recommendations than I was before. And he gave me additional resources for further follow-up. I am most grateful.


Cynthia Norton

Wow! This is a great Eye Care medical facility. I was thoroughly examined by Dr. Pinkhasov for over 2 hours. She made sure to check my eyes for pretty much everything and patiently explained proper care for my eyes. They definitely know how to provide great care and treat their patients right. Now I know why they have such a great reputation and been around for so long.


Steve Fay

Dr. Kavner is a gifted diagnostician and orthoptic therapist. He treated me several decades ago for a condition similar to dyslexia. I was having migraines five times per week. I worked with him for about a year and I experienced tremendous improvement (down to 3-4 per year) that has lasted.


Mary K.

Dr. Kavner recommended two types of eye therapy for my daughter. One of them using bio-feedback. In just three sessions she is seeing considerably better. She shouted this morning: Ooh my God! I could not see these letters with my glasses on, and now I can see them without my glasses. If you are willing and able to invest in improving your vision, this is a good place to go to!


Peter G.

Dr. Kavner recommended two types of eye therapy for my daughter. One of them using bio-feedback. In just three sessions she is seeing considerably better. She shouted this morning: Ooh my God! I could not see these letters with my glasses on, and now I can see them without my glasses. If you are willing and able to invest in improving your vision, this is a good place to go to!


Kinkie F.

I have always found Dr Kavner's work, expertise and wisdom of the highest caliber. As one of the fathers of OT, occupational othomology, his depth and breadth of knowledge about the eyes' health and wellbeing of the patient is exemplary. Cannot say enough good things about him.


Allen B.
1 2 3

Blog

strabismus_esotropia_large-e1627986452983

Dry Eyes After LASIK: Symptoms, Causes, and Treatment Options

LASIK is an eye surgery that has helped many people correct their refractive error and improve their vision. The LASIK […]

Read More
composition-with-contact-lenses-and-accessories-on-LKMZLY51

Can contact lenses get lost in your eye?

Many people who wear contact lenses may have had the concern that their lens could get lost in their eye. […]

Read More
main-2

Macular degeneration: separating fact from fiction- myths and misconceptions

Macular degeneration is the leading cause of blindness in older adults in the United States. Approximately 20 million adults in […]

Read More
see all blogs

Contact Us To Amplify Your EyeCare

Amplify EyeCare Manhattan Logo

Working Hours

Tuesday - Thursday
9:30am–5pm

Friday
9:30am–3pm

Saturday
9:30am–2pm

Sunday
Closed

Location
235 East 67th Street, Suite 201, New York, New York, 10065
Fax
(212) 759-2220
Website Accessibility Policy
Safety protocols page
privacy policy
Cancellation Policy
For Patients
appointment
Call Us
Referrals
Assessments
eyefile-adduserphone-handsetcalendar-fullarrow-uparrow-right linkedin facebook pinterest youtube rss twitter instagram facebook-blank rss-blank linkedin-blank pinterest youtube twitter instagram