Eye Strain & Light Sensitivity After Concussion: Why Can Your Eyes Still Feel Wrong?

Read about the wider assessment and treatment approach for persistent post-concussion symptoms.

Visual symptoms are common after concussion.

Some people become unusually sensitive to light. Others find that reading or using a screen quickly produces eye strain, headache or pressure behind the eyes.

Another pattern we commonly hear at Cranial Solutions is more specific:

Moving the eyes in certain directions feels uncomfortable, restricted or produces a pulling sensation behind or around the eye.

This can be particularly confusing when a standard eye examination shows that visual acuity remains normal.

The reason is that vision involves much more than simply being able to see clearly.

After concussion, symptoms can involve eye movement and coordination, visual processing, neurological sensitivity and the interaction between the eyes, head and neck.

At Cranial Solutions, we are also interested in another part of this picture: the mechanical environment surrounding the orbit, sphenoid, cranial base and dura.

Why Can Vision Feel Different After Concussion?

Seeing clearly requires several systems to work together.

Your eyes must accurately focus and move. Both eyes must coordinate with each other. Your brain must process visual information, integrate it with balance and head movement, and tolerate changes in light and visual complexity.

Concussion can disturb these processes.

People may experience:

• light sensitivity or photophobia
• eye strain
• difficulty reading
• symptoms during screen use
• difficulty focusing
• problems with convergence
• discomfort tracking moving objects
• dizziness or headache in visually busy environments
• pain or pressure behind the eyes
• discomfort or restriction with directional eye movement

These symptoms do not all have the same cause.

That is why persistent visual symptoms after concussion may require appropriate optometric, neuro-ophthalmological, vestibular or neurological assessment depending on the presentation.

But there is also some fascinating anatomy around the back of the eye that is particularly relevant to the Cranial Solutions approach.

The Sphenoid Bone and the Eyes

The sphenoid is one of the central bones of the cranial base.

It sits behind the eyes and contributes to the structure of both eye sockets.

Several openings through the sphenoid transmit important nerves and blood vessels associated with the eyes and face.

Most importantly for this discussion, the optic canal passes through the sphenoid.

The optic nerve travels through this canal on its journey between the brain and the eye.

This places the sphenoid in a remarkable anatomical position:

It is simultaneously part of the cranial base and part of the architecture surrounding the visual system.

That is one reason we pay particular attention to sphenoid and craniofacial mechanics following head trauma.

The Optic Nerve Is Surrounded by the Meninges

The relationship becomes even more interesting when we look at the tissues surrounding the optic nerve.

The meninges surrounding the brain continue along the optic nerve.

This means that the optic nerve does not simply pass independently through the optic canal. It travels within meningeal coverings that are continuous with those inside the cranial cavity.

These coverings continue toward the back of the eye, where the outer layers relate to the scleral tissues.

This establishes an anatomical continuity between the intracranial meningeal environment, optic canal and posterior eye.

That anatomy is established.

What is not established is that post-concussion eye pain or photophobia is necessarily caused by mechanical traction through this pathway.

For Cranial Solutions, the importance is that this anatomy provides a plausible mechanical relationship worth considering alongside the better-established neurological and visual consequences of concussion.

The Ring of Zinn and Eye Movement

There is another important structure at the back of the orbit called the common tendinous ring, or Ring of Zinn.

Several of the extraocular muscles responsible for moving the eye arise from this region around the orbital apex.

These muscles coordinate remarkably precise eye movements.

The Ring of Zinn is closely associated with the sphenoid and structures passing through the orbital apex.

This is particularly interesting when a patient reports that their symptoms are direction-dependent.

For example, looking upward may feel relatively comfortable while looking laterally or downward produces pain, pressure or a pulling sensation.

At Cranial Solutions, directional differences like these form part of the clinical picture.

They do not prove that a particular cranial bone or eye muscle is responsible.

But they give us something useful to assess and reassess.

Why Can My Eyes Hurt Even If I Have 20/20 Vision?

Visual acuity measures how clearly you can resolve detail.

It does not tell us everything about:

• eye movement
• convergence
• visual tracking
• accommodation
• visual processing
• light sensitivity
• vestibular-visual integration
• pain associated with eye movement

It is therefore entirely possible to have excellent visual acuity while still experiencing significant post-concussion visual symptoms.

This is why persistent symptoms should not be dismissed simply because someone can read the bottom line of an eye chart.

What About Light Sensitivity?

Photophobia is a recognised feature of concussion and migraine-like post-traumatic headache.

Light sensitivity involves neurological pathways considerably more complex than the eye functioning as a simple camera.

Retinal signals, visual pathways and trigeminal pain-processing networks can all be relevant.

At Cranial Solutions, we therefore do not assume that photophobia means there is mechanical tension around the optic canal.

However, light sensitivity becomes particularly interesting to us when it occurs alongside a broader pattern such as:

• pressure behind the eyes
• directional eye-movement discomfort
• cranial or facial tension
• headache or head pressure
• restriction through the craniofacial system
• neck or base-of-skull tension

In these cases we assess whether a mechanical component appears to accompany the neurological and visual symptoms.

What We Often Observe With NasalRx

This is where our clinical experience becomes particularly interesting.

NasalRx uses brief, controlled pressure within the nasal passages to influence movement and restriction through the internal nasal and craniofacial structures.

Because the nasal and craniofacial complex has mechanical relationships with the sphenoid and deeper cranial base, treatment can influence a region that cannot be approached in the same way through conventional external manual therapy.

Following NasalRx, we often observe changes in cranial and facial movement, and patients frequently report changes in symptoms associated with the eyes and visual system.

These can include:

• reduced discomfort with directional eye movement
• reduced pressure or aching around or behind the eyes
• improved tolerance of light
• reduced head pressure
• reduced facial or cranial tension
• a feeling that eye movement is easier or less restricted

The directional eye-movement response is particularly useful clinically because it can sometimes be reassessed immediately before and after treatment.

What Do These Changes Mean?

This distinction is important.

If someone can move their eyes in a previously uncomfortable direction with less pain immediately following NasalRx, that is a meaningful clinical observation.

It does not by itself prove that NasalRx has “released the optic nerve sheath” or altered a specific neurological pathway.

There are several structures and systems capable of contributing to visual symptoms following concussion.

What the change tells us is that altering the craniofacial mechanical environment has corresponded with a change in the patient's symptom or function.

When this pattern occurs repeatedly across patients, it becomes clinically important to us and worth further investigation.

Why We Assess the Neck as Well

Eye and visual symptoms after concussion should not be considered solely a cranial problem.

The cervical spine contributes information about head position and movement that must be integrated with visual and vestibular information.

Concussion and whiplash also frequently occur together.

At Cranial Solutions, we therefore assess cervical mechanics alongside the cranial and craniofacial system.

Where cervical restriction is relevant, cervical treatment can be incorporated alongside NasalRx.

When Should Visual Symptoms Be Assessed Elsewhere?

Not every post-concussion visual problem is appropriate for mechanical treatment.

Persistent or significant visual disturbance may require assessment by an optometrist experienced in concussion, ophthalmologist, neuro-ophthalmologist, neurologist or other appropriate practitioner.

New visual loss, double vision, marked neurological change or other concerning symptoms require appropriate medical assessment.

Our role is to determine whether a relevant mechanical component is present alongside the patient's wider post-concussion presentation and recognise when other assessment or rehabilitation is needed.

Frequently Asked Questions

Why do my eyes hurt after a concussion even though my eyesight is normal?

Visual acuity is only one component of vision. Concussion can affect eye movement, convergence, focusing, visual processing, sensory tolerance and other systems even when visual acuity remains normal.

Why does looking in one direction hurt more than another?

Different eye movements require different patterns of extraocular-muscle activity and neurological coordination. Direction-specific discomfort can therefore occur for several reasons. At Cranial Solutions, we record these directional differences because changes following treatment can provide useful clinical information.

What does the sphenoid bone have to do with the eyes?

The sphenoid forms an important part of the cranial base and both orbits. The optic canals pass through it, and the orbital apex and common tendinous ring are closely related to sphenoid anatomy.

Is light sensitivity caused by tension around the optic nerve?

Not necessarily. Photophobia involves complex visual and neurological pathways and is common following concussion and in migraine-like headache presentations. Cranial mechanics may be one factor we assess, but light sensitivity alone does not demonstrate optic-nerve or dural tension.

Can NasalRx help eye strain or light sensitivity after concussion?

Where assessment identifies relevant craniofacial restriction, NasalRx provides a way of influencing this mechanical environment from within the nasal passages.

We often see patients report reduced directional eye-movement discomfort, reduced pressure around the eyes and improved light tolerance following treatment.

Individual responses vary, and persistent visual symptoms may also require specific visual, vestibular or medical assessment.

Still Experiencing Eye Strain or Light Sensitivity After Concussion?

If your eyes have continued to feel strained, painful, sensitive to light or uncomfortable with particular movements after concussion, the next step is determining which components of the problem remain.

Cranial Solutions assesses the cervical, cranial, facial and internal nasal system and determines whether cervical treatment, NasalRx, other concussion rehabilitation, or a combination is appropriate.

Post-Concussion Assessment is available at Cranial Solutions in Auckland and Christchurch.