Why You Should Check the Eyes for a Concussion: A Window Into the Brain

Concussions are not what they used to be. Gone are the days when a young athlete “gets their bell rung,” only to return a few plays later with little concern for the severity of the injury.

I can’t tell you how many men in their 50s come into the clinic, and when asked, “Have you ever had a concussion?” they respond with, “I hit my head a few times, but I never got knocked out, so I don’t think so.”

Now, we know better and have research-backed protocols to ensure concussion recovery doesn’t take longer than it needs to. This article aims to examine how you can check the eyes for a concussion. You’ll walk away with helpful tips and tools for recovery and an understanding of what you can gather by looking at the eyes post-concussion. Let’s dive in.

To effectively check eyes for concussion, it’s important to understand the symptoms and the proper procedures we can follow.

How Do Concussions Happen?

Concussions can happen in several ways. You can hit your head hard, resulting in blunt-force trauma. You can start and stop quickly, causing the brain to bounce around the skull. You can also twist the brain on top of the brain stem and injure the delicate structures more profound in the tissues.

Regardless of how it happens, this sudden movement disrupts the chemical environment and makes it harder for the brain tissue to function at full capacity. While symptoms can vary widely, changes in eye appearance and function are common indicators of concussions and can help a trained clinician pinpoint where the damage has occurred.

Why Do the Eyes Reveal So Much?

When we check eyes for concussion, we look for specific visual indicators that might suggest the severity of the injury.

Checking eyes for concussion can reveal crucial information about the brain’s condition post-injury.

The eyes are helpful after a concussion because so much of the brain is dedicated to making sure they work. Half of the cranial nerves are dedicated to eye function, and a whole lobe of the brain (occipital) is dedicated to processing vision.

It’s vital to know how to check eyes for concussion symptoms to assess the situation accurately.

When you check eyes for concussion, remember that pupil reactions are among the first indicators of injury.

If you’ve ever heard the phrase “the eyes are a window into the brain,” this is true but perhaps a little misleading. A more appropriate phrase would be, “The eyes are the brain.” They are a visible extension of the brain and, thus, a wonderful place to begin examining the after-effects of a concussion.

Let’s get into what to look for.

After a concussion, checking eyes for concussion can help identify issues like blurred vision and light sensitivity.

Key Eye Symptoms to Look For

1. Pupils

   –Pupil size, symmetry, and function are often affected after a concussion. Look for significant differences in size, shape, and responsiveness to light.

   – Sluggish Pupils. When exposed to light, a pupil should constrict and hold the constriction for some time. If you flash the light in the eyes of a concussed person, they may constrict and dilate right away or do nothing at all. If they are unresponsive to light in any way, this indicates a more serious concussion, and you should seek out medical treatment immediately.

2. Eye Movement

   – Nystagmus: This is a sign that the vestibular system or cerebellar tissues have been damaged. Nystagmus can sometimes be hard to see with the eyes open, as visual fixation has the power to suppress it. Dizziness is nearly always present with nystagmus.

Understanding how to check eyes for concussion is essential for anyone who may witness an injury.

If you can elicit nystagmus by putting your head in a certain position, it’s likely something called BPPV, and you should consult a vestibular specialist. If it doesn’t happen with the head in a certain position, it’s likely a central nystagmus, and you should consult a functional neurologist.

   -Difficulty tracking objects: Following a concussion, looking at something stationary, or following something as it moves around can be challenging. This makes things like reading, driving, and walking in busy environments like the grocery store potentially difficult.

   -Convergence/Divergence: Issues with convergence and divergence can be challenging in whiplash injuries and concussions involving rotation of the head. This means following objects as they come closer to you and following them as they move away.

Looking at something close and then quickly looking at something far away can also cause symptoms. These areas are located in the same region of your brainstem (midbrain), so they often occur together.

   -Optokinetic Reflexes: These are the automatic eye movements that happen when you look out of a car, and your eyes bounce from thing to thing. They should be wholly involuntary and often break down with a concussion. When these break down, car rides and travel become unbearably uncomfortable.

3. Vision Changes

Make a habit of learning how to check eyes for concussion as part of any sports safety protocol.

   – Blurred or double Vision: Altered Vision after a hit to the head can stem from a few things. The alignment of the eyes can become skewed, resulting in double Vision. Eye doctors are good at fixing this issue.

The control of the pupils can become altered after a concussion. There is a delicate interplay of systems that control how much light gets let in and how tense the pupil muscles are. This allows you to focus on near/far objects. When this function is altered, your prescription may change, and it may be harder to judge depth perception.

   Sensitivity to light (photophobia): Similar to near/far sight, pupil control is often affected after a brain injury. When the brain perceives damage or a threat, it dilates the pupils and lets a lot of light in. This can make regular amounts of light seem very bright and may trigger a headache.

Step-by-Step Procedure to Check Eyes for Concussion

1. Find a Well-Lit Area:

   – Ensure adequate lighting to observe pupil size and response accurately. Ensure there is minimal texture or movement immediately behind you, as this may exacerbate the person’s symptoms.

2. Examine Pupils:

   – Use a flashlight to gently illuminate each eye and observe pupil size and speed of constriction.

   – Note any size discrepancies or inability of the pupil to constrict. Also, note if they wince when you flash the light into their eyes. If their pupils are already dilated from the accident, it may cause some discomfort.

Note: Examining this is a skill most clinicians take years, sometimes decades, to master. If you’re reading this and you don’t have any medical training in what to look for, there is a user-friendly app called Reflex that will do all the heavy lifting for you. I have no affiliation with the app; I just think it’s helpful.

3. Test Eye Movement:

   – Have the individual follow a small object (like a pen) with their eyes, moving it slowly left, right, up, and down. After this, ask them to follow the pen close to their nose and then follow it as you bring it back roughly 2 feet away from them.

   Look for jerky movements, turning of the head to help follow, dilation of the pupils, and/or a large increase in blink rate. If this is an issue, they will also commonly report symptoms such as headache, nausea, eye strain, and anxiety.

When you check eyes for concussion, you may observe critical signs that others might overlook.

Always remember to check eyes for concussion before proceeding with any other assessments or actions.

4. Assess Vision:

   – Ask the individual to describe changes in their Vision, such as blurriness or seeing double. A simple Snellen eye chart can be used on a computer as a rough way to see whether or not visual acuity has been affected.

   – Inquire about trouble reading, if their glasses seem to cause eye strain, or if they are squinting more than usual.

In summary, knowing how to check eyes for concussion can make a significant difference in injury evaluation.

After checking eyes for concussion, you will be better equipped to make informed decisions about the injured individual’s care.

Regularly check eyes for concussion to ensure early detection and proper management of potential brain injuries.

Finally, it’s essential to check eyes for concussion to ensure the best possible recovery outcomes after an injury.

If you suspect a concussion, knowing how to check eyes for concussion symptoms can guide your next steps.

5. Observe Balance:

Ultimately, a thorough check of the eyes for concussion symptoms can provide vital insights into a person’s condition.

   – Conduct simple balance tests, such as standing on one foot or walking straight, watching for instability or swaying related to vision problems.

-Some other simple tests include standing heel to toe and closing your eyes.

-Make sure to test with the eyes open and closed, as this tells you whether or not they need visual input to stay balanced. If they do, you’re likely dealing with a vestibular injury.

What to Do if You Suspect a Concussion

If any of these visual symptoms are present, seeking medical attention is crucial. While not all eye changes definitively indicate a concussion, they warrant professional evaluation to rule out severe brain injury.

If you go to a neurologist whose testing does not reveal any significant injury, consult a functional neurologist. They’re trained to identify functional issues with the brain and are better equipped to identify the underlying injury.

Conclusion

Checking the eyes after a concussion can save you time and money figuring out what to do. It can inform you as to whether or not you need immediate medical attention and can often point you in the right direction regarding seeking care.

Remember: the eyes are the only part of the brain you can see with the naked eye. They’re not part of your brain; they ARE your brain. Paying attention to how your eyes work after a concussion is a crucial part of making good choices and achieving a full recovery.

Stay safe, and always prioritize brain health!

If you have questions about concussion recovery, click here to schedule a complimentary consultation with one of our doctors. We’ve treated hundreds of complex neurologic cases and can help piece together the missing pieces in your recovery.

*Note: The information provided in this article is for educational purposes only and does not constitute a doctor-patient relationship. Patients should consult their medical provider or primary care physician before trying any remedies or therapies at home.