How Binocular Vision Dysfunction Relates to TBI
Traumatic Brain Injury, or TBI, is a condition which many people in the U.S. suffer from. TBI causes a variety of different issues and symptoms, but the two that are seen most frequently are headaches and dizziness. Those with TBI are understandably troubled by these symptoms and their side effects, and patients often undergo exhaustive evaluations and testing in an effort to find answers and relief from their symptoms.
Specialists commonly consulted for evaluation include chiropractors, ENT / vestibular specialists / otologists, PM & R and psychiatrists. In many cases, those with TBI have tried many different therapies and medications, searching for the link between TBI and headaches, but often see little to no change in the frequency and severity of their symptoms. It has now become evident that a little-known visual condition called Binocular Vision Dysfunction is the cause of many occurrences of headaches and dizziness in these patients.
Binocular Vision Dysfunction, Superior Oblique Palsy & Vertical Heterophoria
In patients with Binocular Vision Dysfunction, the eyes are slightly out of alignment with each other. In other words, the line of sight from one eye doesn’t line up with that of the other one, which makes it extremely difficult for the eyes to see a single image. Doctors have found that TBI can bring on BVD, the two most recognized forms of which are Superior Oblique Palsy (SOP) and Vertical Heterophoria (VH).
A significant cause of SOP and VH seems to be a disconnect between the two systems that aim and focus the eyes: the visual (or oculomotor) system and inner ear (or vestibular) system. When the vestibular system doesn’t work correctly, a small and subtle misalignment of the eyes can occur. If left uncorrected, this misalignment can cause double vision, which the human body does not allow. To stop the double vision and realign the eyes, the oculomotor system shifts the eyes in the opposite direction, toward their original position. Then the defective inner ear system asserts itself again, moving the eyes out of alignment once more, forcing the visual system to make another correction.
This persistent cycle of misalignment followed by realignment can give rise to a variety of symptoms. These can include pain in the eyes and headaches caused by fatigue and eye muscle strain, along with motion sickness, nausea, lightheadedness, dizziness, nausea and anxiety, a result of the repetitive back-and-forth movements of the eyes.
Head tilt is another method the body uses to realign the eyes. As the head is tilted down toward the shoulder, the images in the eyes line back up. This corrects the misalignment, but can also lead to persistent neck pain.
People with BVD often experience additional symptoms along with dizziness and headaches. These can include:
- Vestibular symptoms. Bad depth perception, nausea, motion sickness, drifting and/or instability when walking, poor coordination (symptoms also found in people with Meniere’s disease, sequelae of a stroke, MS and inner ear disorders).
- Vision problems. Overlapping or double vision, blurred or shadowed vision (symptoms frequently seen in MS patients), issues with reflection or glare, sensitivity to light.
- Pain symptoms. Pain in the upper back and achiness in the neck caused by head tilt (symptoms often felt by patients with spinal misalignment), a feeling of achiness in the face, pain when moving the eyes or general eye pain (symptoms also experienced by those with TMJ problems, sinus issues, migraines).
- Reading difficulties. Problems with reading and comprehension, frequently losing one’s spot when reading, words blurring or running together when reading, accidentally skipping lines when reading (similar to the symptoms experienced by those with learning disabilities), trouble concentrating (comparable to someone with ADHD).
- Psychological symptoms. Feeling anxious or unsettled in big crowds and large, open buildings with high ceilings, like a department store or mall (patients with agoraphobia or anxiety exhibit similar symptoms).
For some people who experience TBI and headaches, along with other symptoms of BVD, their symptoms may be few enough or mild enough to be more of an inconvenience than a serious problem in their lives. Others aren’t so lucky; some patients experience BVD symptoms that are so numerous or severe that they’re incapacitated and afraid or unable to leave the house.
Treatment of BVD
In order for patients to receive relief from the symptoms of BVD brought on by TBI, it’s necessary to have a NeuroVisual Evaluation to identify any slight vision misalignments that may be present. This comprehensive and detailed examination is needed because standard eye exams typically aren’t able to detect these small amounts of misalignment.
At Old Saratoga Eyecare, problems with visual misalignment, far vision and near vision are corrected through the use of special glasses with aligning lenses that contain prism. This treatment method is extremely effective; patients almost always experience a dramatic easing of their symptoms, and sometimes the symptoms go away completely.
Schedule a NeuroVisual Examination
The team at Old Saratoga Eyecare wants to help you find relief from dizziness and headaches caused by TBI. Call us at (518) 692-2040 or fill out our screening questionnaire to get started on the path to recovery.