Neuro-Optometric Rehabilitation to Prevent Post-concussion Visual Complications: A Case Report

A concussion is a mild traumatic brain injury (mTBI) caused by an insult to the brain from an outside force. It is a concerning health issue affecting all ages, sexes, and races. Diagnosing mTBI involves physical tests, as mTBI can't be seen through imaging, such as CT or MRI scans. Management of an mTBI is typically rest and over-the-counter medications; however, mTBI can cause complications such as photosensitivity and ocular dysfunction. In this context, this article presents a case report of a 15-year-old hockey player who was hit in the face by an elbow at high speed. The patient was initially diagnosed with a minor laceration and cleared to play. The following day, the patient developed standard mTBI symptoms. Early evaluations downplayed the mTBI severity, which led to worsening symptoms, notably visual impairment. The patient was prescribed amitriptyline, an off-label prescription, for insomnia, only to worsen his condition. The delayed proper treatment and therapy prolonged his recovery. Ultimately, neuro-optometry, physical therapy, and occupational therapy helped improve his vision and balance. The neuro-optometrist properly diagnosed binocular vision dysfunction (BVD) or strabismus and prescribed prism eyeglasses for vision therapy. This case emphasizes the risks of misdiagnosing mTBI, off-label prescriptions, and delayed vision therapy. It highlights the importance of prompt and accurate care by utilizing a team approach involving neuro-optometrists or neuro-ophthalmologists if there are visual symptoms during the acute phase of concussion.