06 / Post-concussion & TBI

Why Do My Eyes Hurt and Feel Strained After a Concussion? The Dural-Optic Canal Link

Cranial Solutions26 July 20256 min read

Post-concussion eye pain, tracking difficulty and strong light sensitivity (photophobia) are associated with dural membrane continuity through the optic canal. The dura mater does not stop at the brain; it extends through the optic canal as a continuous sheath around the optic nerve and blends into the posterior sclera (white wall) of the eye. When a head impact restricts the sphenoid bone, the resulting dural torsion may pull on this optic sheath and alter tension at the eye muscle attachments, which is associated with pain behind the eyes and convergence strain.

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The Biomechanical Problem: The Anatomical Bridge Between Dura and Eye

People recovering from a concussion often report that screens, reading or moving their eyes side to side bring on a deep ache behind the eyes and more head pressure. Standard eye exams often show normal visual acuity, because the issue may lie in the mechanical link between the skull's dural lining and the eyes.

From Sphenoid Strain to Eye Pain

Step 1: Sphenoid restriction and dural torsion after trauma.
Step 2: Traction along the optic canal dural sheath.
Step 3: Pull on the back of the eye and eye muscle imbalance.
Step 4: Trigeminal (CN V1) sensitisation, associated with pain behind the eyes and light sensitivity.

Anatomical continuity explains this connection:

The optic dural sheath: as the optic nerve (CN II) passes into the eye socket through the optic canal in the sphenoid bone, it is wrapped in a continuous extension of the dura mater.
Posterior scleral fusion: at the back of the eyeball, this sheath blends into the fibrous sclera.
Ring of Zinn attachments: the tendon ring where the four rectus eye muscles begin attaches to the dural lining around the optic canal.

When a concussion twists the sphenoid bone, it may place traction on the optic dural sheath, pulling on the back of the eye and unbalancing the eye-tracking muscles.

See how these drivers are assessed on our Post-Concussion Symptoms & TBI page.

Comparison: Standard Eye Model vs. Dural-Optic Traction Model

Primary assessment

Standard refractive eye model: Eyeball shape, lens focus and visual acuity.
Dural-optic traction model: Dural membrane tension and optic sheath traction.

Eye pain origin

Standard refractive eye model: Often assumed to be eye muscle fatigue or dry eye.
Dural-optic traction model: Mechanical pull on the back of the eye and CN V1.

Light sensitivity

Standard refractive eye model: Managed with dark glasses or screen filters.
Dural-optic traction model: Sensitisation of dural trigeminal pathways.

Convergence fatigue

Standard refractive eye model: Managed with isolated eye exercises.
Dural-optic traction model: Sphenoid dural torsion pulling on eye muscles.

Structural driver

Standard refractive eye model: Local eyeball anatomy.
Dural-optic traction model: Restricted sphenoid and optic canal dural sheath.

Clinical feature	Standard refractive eye model	Dural-optic traction model
Primary assessment	Eyeball shape, lens focus and visual acuity.	Dural membrane tension and optic sheath traction.
Eye pain origin	Often assumed to be eye muscle fatigue or dry eye.	Mechanical pull on the back of the eye and CN V1.
Light sensitivity	Managed with dark glasses or screen filters.	Sensitisation of dural trigeminal pathways.
Convergence fatigue	Managed with isolated eye exercises.	Sphenoid dural torsion pulling on eye muscles.
Structural driver	Local eyeball anatomy.	Restricted sphenoid and optic canal dural sheath.

How Dural Traction Is Associated With Eye Symptoms

Strain on the optic dural sheath is associated with three distinct symptoms:

Aching Behind the Eyes

Asymmetric dural torsion may pull on the back of the eye, stimulating dural pain receptors supplied by the ophthalmic branch of the trigeminal nerve (CN V1).

Convergence Weakness

Because the eye muscles begin at the dural lining of the optic canal, dural traction may alter their resting tone, making it harder for the eyes to work together on close objects.

Light Sensitivity (Photophobia)

Irritation of trigeminal dural pathways may sensitise brainstem pain pathways, so that normal light is felt as painful glare.

Screens, reading or bright light still uncomfortable after a head knock? Read more on our Post-Concussion Symptoms & TBI page.

Supporting Movement and Fluid Dynamics

Easing dural-optic traction involves addressing sphenoid restriction and internal dural strain:

Endonasal inflation (Nasal RX): controlled, brief inflations within key inner nasal passageways apply gentle pressure that aims to mobilise the sphenoid bone and surrounding facial sutures.
Easing the optic sheath: supporting sphenoid alignment aims to reduce traction on the optic dural sheath and eye muscle attachments.
Supporting comfort: reducing dural strain aims to calm sensitised trigeminal pathways, which may ease light sensitivity and eye pain. Individual results vary.

Frequently Asked Questions

Why do my eyes hurt when my eye test shows normal vision?

Standard eye exams test how well your eyes focus light. Post-concussion eye pain may not be a focusing issue; it is associated with dural torsion pulling on the optic sheath and eye muscles attached near the sphenoid bone. Learn more on our Post-Concussion Symptoms & TBI page.

What connects the dura inside the skull to the back of the eye?

The dura mater extends through the optic canal as a continuous sleeve around the optic nerve, and this sleeve blends into the sclera (the white outer wall) at the back of the eye. Read What Is Dural Torsion?

How might endonasal inflation help with light sensitivity after a concussion?

Light sensitivity is associated with dural traction irritating the trigeminal nerve (CN V1). Nasal RX uses gentle, brief inflations that aim to mobilise the sphenoid bone and ease dural strain around the optic canal. Suitability is discussed after individual assessment.

For the full overview, visit our Post-Concussion Symptoms & TBI page.

Read the related article What Is Dural Torsion?

Also see The Eye-Dura Connection

Eye pain can overlap with Migraines & Headaches.

Learn about our clinical approach.

Browse the published studies on our Research page.

References

01Dura Mater & Migraines Synthesis Report (2025). Biomechanical stiffness (28-86 MPa) and dural mechanics.
02Dural Attachment Points & Sutures Report (2025). Sphenoid crista galli, clinoid processes, and petrous temporal ridge anchor mechanics.
03Dural Tension & Optic Sheath Synthesis (2025). Optic dural sheath continuity, posterior scleral fusion, and photophobia.
04Levy D. (2009). Meningeal neurogenic inflammation, dural mast cell degranulation, and CGRP. Curr Pain Headache Rep, 13(3): 237-240.
05Li et al. (2021). Non-invasive optic nerve sheath diameter (ONSD) measurement and intracranial pressure dynamics. Quant Imag Med Surg, 11(4): 1200-1211.
06Standring S. (2016). Gray's Anatomy: The Anatomical Basis of Clinical Practice. Elsevier. pp. 670-672.
07PMC Review (2023). Microsurgical Anatomy of the Common Tendinous Ring. PMC, 12068757.
08Ventura RE et al. (2016). The neuro-ophthalmology of head trauma. Lancet Neurol, 14(6): 606-619.

Learn how our non-surgical endonasal protocol is used to evaluate suitability for conservative management, and how cranial base structural mechanics guide an individual care plan.