Understanding photophobia in mTBI patients

Photophobia or photosensitivity, is one of the more common conditions associated with a traumatic brain injury, experienced by approximately 50% of patients.

Understanding photophobia in mTBI patients in Santa Clarita

One of the most common symptoms reported after a head injury is photophobia or light sensitivity. This is experienced both by those who have had a serious head injury (TBI or traumatic brain injury) as well as a mild head injury (mTBI). 

Mild TBI (mTBI), which is typically defined by Glasgow Coma Scale score ≥ 13, accounts for the vast majority of all TBIs, particularly in the setting of sports-related injuries. The Glasgow Coma Score is a method for assessing the patient's extent of consciousness after a traumatic brain injury.

At our specialty eye care center we provide advanced care for patients who experience light sensitivity following a stroke, concussion or neurological condition. We are proud to provide cutting edge neuro optometric rehabilitation services to patients from all over California, and we are proud to be a leading provider of neuro-optometric rehabilitation services for patients from Santa Clarita, Palmdale, Lancaster, and San Fernando Valley.

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What are the most common symptoms and conditions you may experience following a mTBI?

A mTBI can result in a variety of visual complications. These are some of the most common visual-related conditions and symptoms:

  • Oculomotor dysfunction
  • Convergence insufficiency
  • Accommodative dysfunction
  • Dry eye
  • Photophobia
  • Visuo-spatial disorientation
  • Dizziness
  • Headache
  • Sleep disorders
  • Photophobia, or photosensitivity, is one of the more common conditions associated with TBI, experienced by approximately 50% of patients.
  • The reduced peripheral field (also known as collapsed fields) is another common mTBI symptom.

The conditions described above are in some way related to one another. There is a link between convergence problems and accommodative problems, for example. Another example is headaches and photophobia. Post Traumatic Vision Syndrome was described by William V. Padula, OD, as a cluster of vision and spatial disorders that affect people who have suffered a neurological event, such as a traumatic brain injury, a cerebral vascular accident, multiple sclerosis, or another neurological disorder.

If you are experiencing any of the above symptoms and conditions following a traumatic brain injury, you don't have to suffer any longer. It is possible to alleviate these symptoms with a customized neuro-optometric rehabilitation plan and continue to do your everyday tasks without difficulty and sensitivity to light. To schedule a neuro-optometric evaluation, please call (661) 775-1860.

How does a TBI affect your visual ability?

Often, when the visual system isn't functioning appropriately after a neurological/traumatic injury, we see a high level of exophoria (one eye drifting out) or exotropia (eye misalignment where one eye deviates outwards). Due to this additional effort, the visual system is stressed and activates the proprioceptive fibers in the extraocular muscles, which transmit signals to the trigeminal ganglion indicating the added effort. Nerve signals sent to the trigeminal ganglion activates pain signals through the thalamus and up to the cerebral cortex. Patients may experience headaches, light sensitivity, or dizziness.

How does a TBI affect your visual ability?
What is the connection between light sensitivity and traumatic brain injuries?

What is the connection between light sensitivity and traumatic brain injuries?

Photophobia is closely linked to pain sensation. It is the trigeminal nerve and its nuclei that are responsible for sensations of pain in the head. Several parts of the eye are densely innervated with trigeminal fibers and sensitive to pain, including the conjunctiva, cornea, sclera, and uvea (iris, ciliary body, and choroid). Photophobia is usually caused by painful stimuli to these areas (e.g. corneal abrasion, iritis, uveitis).

What is the connection between light sensitivity and traumatic brain injuries?

What is the mechanism that triggers light sensitivity in TBI?

On a pathophysiological level, let's examine some of the more common mechanisms. The retina contains photosensitive cells known as rods, cones, and intrinsic photosensitive retinal ganglion cells (ipRGCs). In the human retina, rods and cones are the predominant photosensitive cells. Melanopsin is found in the intrinsic photosensitive retinal ganglion cells. These cells specifically detect luminance levels, but they do not support vision. The ipRGC sends axons to the suprachiasmatic nucleus of the hypothalamus, and these axons control circadian rhythms. In addition, the ipRGC cells also send axons to the Edinger-Westphal nucleus to control the pupil light reflex. In the human retina, there are only 3,000 of these cells, representing .2% of all RGCs. These cells are photoreceptive, with maximum sensitivity to blue light within the 460-480 nm range. A patient with a traumatic brain injury may have a poorly regulated melanopsin-signaling system when exposed to light.

Does visual field loss occur in patients with light sensitivity?

In patients with photosensitivity, visual fields are important. It was noted by Christine T. Langerhorst and Avinoam B. Safran that there were generalized constrictions in the visual field. While the authors attributed it to an attention disorder, Jackowski attributed it to loss of rod-mediated activity related to dark adaptation. All patients reporting photosensitivity had visual field losses within the central 30 degrees when Jackowski used frequency doubling technology (FDT). Rods affect magnocellular loss, which affects the FDT. These patients reported collapsing visual fields during testing. Kinetic fields, such as Octopus or Goldmann, can also be used to map the visual field constriction. It was found that the FDT and kinetic fields show a strong correlation with visual field constriction.

How does a TBI affect your visual ability?
What is the connection between light sensitivity and traumatic brain injuries?

How is light sensitivity treated and managed in patients with mTBI?

The degree of light sensitivity caused by mTBI varies from mild to severe. The most severe cases might require patients to wear sunglasses constantly, even indoors. They may be sensitive to fluorescent lighting as well as digital devices, which emit a lot of blue light. With the introduction of filters and vision rehabilitation, light sensitivity can be improved even when it is severe and of long duration. 

The goal is to relieve symptoms with specific filters and to take the patient off the use of sunglasses indoors. Photosensitivity is associated with visual fatigue. It often occurs in conjunction with binocular vision problems, and is not a standalone condition. Binasal occlusion is used to reduce binocular stress in patients with mTBI. Through binasals, the system becomes less hyper-focused, which reduces sensitivity to light. Additionally, blue filters may reduce symptoms of indoor light sensitivity. Polaroid, blue-blocking filters, and FL-41 filters can be used outdoors to tone down the brightness.

Photophobia is a complex subject. Research in the future will provide us with a deeper understanding of photophobia in mTBI patients and allow us to provide better treatment for them.

Common Questions

In some cases, photophobia may be temporary and resolve on its own or with treatment. In other cases, it may be a long-term or permanent condition. Since there are a variety of causes for light sensitivity it is very important to schedule a neuro optometric evaluation to fully understand what is causing your symptoms.
Some people find relief from photophobia with home remedies such as using artificial tears, wearing sunglasses or a hat to block out bright light, or taking breaks from screens and other sources of artificial light. However in most cases these home remedies are not adequate to solve the issue. When you schedule a neuro optometric evaluation we spend time assessing the root cause of your light sensitivity as well as discussing the various treatment options such as binasal glasses and specialized filters. It is important to note that home remedies are generally not effective for everyone and are not a substitute for proper medical treatment by an eye doctor.
If you are experiencing photophobia and it is severe, persistent, or causing discomfort, it is important to see a neuro optometrist. You should also see a neuro optometrist if you are experiencing other symptoms that may be related to an underlying condition, such as eye pain or changes in vision. In many cases light sensitivity can be remedied by using filtered lenses or binasal glasses, these is a fairly simple solution and does not require a major investment, we highly recommend scheduling a neuro optometric evaluation to treat your light sensitivity.
Understanding photophobia in mTBI patients
Dr. Garbus, FAAO cartoon

Schedule a neuro optometric evaluation near you

If you or a loved one has suffered a traumatic brain injury and has been suffering from light sensitivity or any of the above listed visual conditions, please schedule a neuro-optometric evaluation with Dr. Garbus, FAAO.

Dr. Carl Garbus, FAAO has served patients in Santa Clarita since 1980. The practice is a full scope medical and specialty eye care clinic that emphasizes care for children and adults with vision deficits from traumatic brain injury, stroke and developmental and learning problems. The practice has the latest technology to provide advanced medical eye care services including low vision, specialty contact lenses, myopia management, ocular disease, dry eye and routine eye care/optical.

Dr. Carl Garbus, FAAO has a passion for working with the expanded care team and does extensive work with the leading rehabilitation hospitals around the greater Los Angeles area. He has made various presentations and in-services to optometric societies, occupational therapy groups, and PTA groups regarding vision problems. Another area of interest is working with children who have learning problems. Autism is on the rise and these children have many vision issues that need to be addressed. Dr. Carl Garbus, FAAO serves as the vice president on the board for the Neuro Optometric Rehabilitation Association (NORA) and was the president of the organization in 2010.

Dr. Garbus’s many accomplishments include: 

  • 2 term President of NORA (Neuro Optometric Rehabilitation Association)  
  • Awarded the founding father medal from NORA (Neuro Optometric Rehabilitation Association)
  • Former Chair and long standing member of AOA Vision Rehabilitation Committee
  • Former president of the Los Angeles County Optometric Society 
  • Member of AOA, COA, NORA
  • Member of the Academy of optometry FAAO  
  • Hospital privileges and consults at Cedars Sinai Medical Center in Los Angeles, Cottage Hospital in Santa Barbara and Henry Mayo Hospital in Santa Clarita
  • Works with Centre For Neuro Skills, Solutions At Santa Barbara and the Brain Injury Specialists
  • Various published articles: Read the articles 
  • Lecturer at AOA (American Optometric Association) 

To schedule a neuro optometric evaluation, please call (661) 775-1860. Those who have suffered a traumatic brain injury and have been suffering from visual conditions visit our clinic from all over California, and we are proud to be a leading provider of neuro-optometric rehabilitation services for patients from Santa Clarita, Palmdale, Lancaster, and San Fernando Valley.

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Testimonials


  • My eight year old daughter was terrified to go to the eye doctor for fear of her eyes being dilated. The doctor was SO KID friendly! He immediately made her comfortable by engaging her in conversation. It was a geat experience.


    Joya B.

  • Dr. Garbus spent an amazing amount of time to solve my very complicated visual problems. Over the years he has continually achieved results beyond what others felt possible. He is always up to date on the latest science. He is great!


    Dolores K.

  • Family Vision Care Valencia makes it so easy. Staff is knows what they are doing and Dr. Garbus is thorough and kept me well informed during the exam.


    Kristy B.

  • I have been coming to Family Vision Center for almost 20 years. Dr. Garbus has been able to help my vision when other doctors could not. Now my kids see him as well. I highly recommend this office!


    Autumn C.

  • The Doctor is very good. I felt on this visit he seemed rushed. I had questions to ask him but he was already with another patient. I still do not know if my eyes are the same , worse, or better.


    Howard B.

Testimonials


My eight year old daughter was terrified to go to the eye doctor for fear of her eyes being dilated. The doctor was SO KID friendly! He immediately made her comfortable by engaging her in conversation. It was a geat experience.


Joya B.

Dr. Garbus spent an amazing amount of time to solve my very complicated visual problems. Over the years he has continually achieved results beyond what others felt possible. He is always up to date on the latest science. He is great!


Dolores K.

Family Vision Care Valencia makes it so easy. Staff is knows what they are doing and Dr. Garbus is thorough and kept me well informed during the exam.


Kristy B.

I have been coming to Family Vision Center for almost 20 years. Dr. Garbus has been able to help my vision when other doctors could not. Now my kids see him as well. I highly recommend this office!


Autumn C.

The Doctor is very good. I felt on this visit he seemed rushed. I had questions to ask him but he was already with another patient. I still do not know if my eyes are the same , worse, or better.


Howard B.

All the staff is friendly, helpful and knowledgeable, and has been for all the years I have been going there.


Mary Ann H.
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