Functional Examples of Vision Problems After Brain Injury (TBI/Stroke)

Vision changes after a brain injury are common and often misunderstood because the eyes may be healthy while the brain’s visual processing is affected. These problems can significantly disrupt daily function—reading, walking safely, working on screens, driving, and even recognizing people. Below are practical, real-world examples of vision problems that can occur after traumatic brain injury (TBI), stroke, or other acquired brain injuries, with a focus on how they show up in everyday life.

1) Double Vision (Diplopia)

**What it can look like functionally:**

- Seeing two images of a single object, especially when tired or focusing up close.

- Difficulty pouring liquids because the cup appears “shifted.”

- Trouble walking down stairs because steps appear doubled or misaligned.

- Avoiding busy environments because overlapping images feel disorienting.

**Common day-to-day impact:** headaches, nausea, eye strain, reduced balance confidence, and slower task completion.

2) Blurred Vision That Comes and Goes

**Functional examples:**

- Vision is clear in the morning but becomes blurry after reading or screen use.

- Difficulty shifting focus from phone to TV or from dashboard to road signs.

- Needing frequent breaks during paperwork because print “fades” or smears.

**Common day-to-day impact:** reduced reading endurance, errors at work, and increased fatigue.

3) Light Sensitivity (Photophobia)

**Functional examples:**

- Fluorescent lights in offices or stores trigger pain, tearing, or headaches.

- Avoiding outdoor activities because sunlight feels “too sharp.”

- Difficulty driving at night due to glare from headlights.

- Needing sunglasses indoors or preferring dim rooms.

**Common day-to-day impact:** social withdrawal, reduced community participation, and difficulty returning to work.

4) Visual Field Loss (Hemianopia/Quadrantanopia)

This is loss of vision on one side (or a quarter) of the visual field, often after stroke.

**Functional examples:**

- Bumping into doorframes, furniture, or people on the affected side.

- Missing food on one side of the plate or leaving half the meal untouched.

- Reading only the right half of a page or losing the start/end of lines.

- Difficulty navigating crowds because obstacles “appear suddenly.”

**Common day-to-day impact:** safety risks, reduced independence, and challenges with driving eligibility.

5) Visual Neglect (Inattention to One Side)

Different from field loss: the eyes may “see,” but the brain doesn’t attend to that side.

**Functional examples:**

- Shaving or applying makeup to only one side of the face.

- Dressing only one side of the body or forgetting one sleeve.

- Ignoring people speaking from the affected side.

- Colliding with objects on one side despite “looking” forward.

**Common day-to-day impact:** high fall risk, reduced self-care accuracy, and need for structured scanning strategies.

6) Eye Movement Problems (Saccades and Pursuits)

The brain controls quick eye jumps (saccades) and smooth tracking (pursuits). After injury, these can be inefficient.

**Functional examples:**

- Losing place while reading; skipping lines or rereading the same line.

- Difficulty tracking a moving object (sports, kids running, traffic).

- Feeling overwhelmed in visually busy places because the eyes can’t “organize” the scene.

**Common day-to-day impact:** slower reading, reduced comprehension, and increased fatigue in complex environments.

7) Convergence Insufficiency (Trouble Aiming Both Eyes Up Close)

Common after concussion and other TBIs.

**Functional examples:**

- Print “moves,” doubles, or becomes uncomfortable after a few minutes.

- Avoiding texting, forms, or computer work because symptoms build quickly.

- Headaches centered around the eyes or forehead during near tasks.

**Common day-to-day impact:** reduced school/work tolerance and difficulty with sustained near focus.

8) Depth Perception Problems

Depth perception relies on coordinated eye alignment and brain processing.

**Functional examples:**

- Misjudging curbs, steps, or the distance to a chair when sitting down.

- Difficulty parking a car or judging gaps in traffic.

- Reaching for objects and consistently grabbing short or knocking them over.

**Common day-to-day impact:** falls, spills, and reduced confidence with mobility.

9) Motion Sensitivity and Visual Vertigo

Some people feel dizzy or nauseated when the visual world moves.

**Functional examples:**

- Feeling unsteady in grocery aisles (repeating patterns, lots of motion).

- Dizziness when scrolling on a phone or watching fast camera movement on TV.

- Trouble riding in a car, especially in heavy traffic or rain.

**Common day-to-day impact:** avoidance of community activities and increased reliance on others for errands.

10) Difficulty Recognizing Faces or Objects (Visual Agnosia/Prosopagnosia)

Less common, but highly disruptive when present.

**Functional examples:**

- Recognizing a voice but not the person’s face.

- Confusing similar-looking objects (e.g., remote vs. phone) unless labeled.

- Needing contextual clues (clothing, location) to identify people.

**Common day-to-day impact:** social anxiety, embarrassment, and safety concerns in unfamiliar settings.

11) Reading-Specific Problems (Acquired Alexia or Visual Processing Issues)

Even with “20/20” eyesight, reading can be impaired.

**Functional examples:**

- Letters appear jumbled, crowded, or hard to track across a line.

- Reading is accurate but extremely slow and exhausting.

- Comprehension drops because so much effort goes into tracking words.

**Common day-to-day impact:** difficulty with bills, medication labels, work documents, and leisure reading.

12) Visual Fatigue and Reduced Visual Stamina

A frequent complaint after brain injury.

**Functional examples:**

- Symptoms worsen later in the day: blur, headaches, dizziness, irritability.

- Needing frequent breaks from screens, reading, or driving.

- Performing well in short appointments but struggling at home for longer tasks.

**Common day-to-day impact:** inconsistent performance and challenges returning to full-time work or school.

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When to Seek Help

If vision changes appear after a brain injury—especially if they affect safety, reading, balance, or driving—an evaluation is important. Many people benefit from coordinated care such as neuro-optometry, ophthalmology, occupational therapy (vision rehab), and vestibular therapy, depending on the pattern of symptoms.