Advances in the Management of Oculomotor Dysfunction in Adults and Children with Concussion

Oculomotor Dysfunction, inclusive of pursuits, saccades, accommodation and vergence abnormalities, affects more than 60% of concussed children and adolescents, and more than 90% of concussed adults. While full recovery is generally expected within weeks or up to 3-months, some patients may have prolonged or persistent symptoms lasting weeks, months, or years. This chapter covers the diagnosis and management of oculomotor dysfunction in adults and children with concussion in its acute, subacute, and chronic phases. Assessment of fixation, saccadic eye movements, smooth pursuit eye movements, accommodation, vergence, binocularity and vestibular-ocular function are reviewed along with creation of an appropriate treatment plan. The rationale for each treatment option is discussed including the use of lenses, prisms, spectral filters (tints), and Neuro Optometric Rehabilitation Therapy. Today, the eye and vision care community should recognize these visual issues associated with concussion or mild traumatic brain injury and treat or refer these patients for what is considered the best medical care.