Beginning Eye Exercises After a Concussion

By Guest Blogger Michelle Rogers PT, DPT

Concussions can affect many parts of your life, and frequently affect both vision and the vestibular (balance) system. This can happen in a few ways. The impact can cause direct eye damage, eye muscle damage, or brain damage to the areas of the brain involved in vision and balance. Specific eye symptoms that were seen in 34% of concussion patients in one study included eye strain or fatigue, difficulty with near or far distance, light sensitivity, headaches, blurred vision, pressure around the eyes, and vision-related nausea (1). Because vision plays such a large part in the balance system, it makes sense that many people also experience dizziness and vertigo.   It is so important to get a full evaluation after a concussion to find your impairments and figure out the best way to address them.

Just like an orthopedic injury, there are exercises you can do to help get your eyes back to normal after a concussion.  Each of the following exercises has you focus on a target while moving your eyes or head (or both). Your doctor and physical therapist can help you determine when and how is safest to start doing these exercises after a concussion. There is a benefit to a period of rest from activities including scholastic activity, video games, computer usage, text messaging, television screen time before slowly beginning an exercise protocol (2). You may start the exercises seated initially, and may feel more comfortable in a dimly lit room, or wearing sunglasses. You should stop when you have a noticeable increase in symptoms. Take breaks in between each exercise to take stock of your symptoms like dizziness, nausea or a headache. Stop if these are increasing quickly. You may initially have very little tolerance to any of these exercises, but be able to slowly build up over time. In each of the following exercises, you will work with a visual target. Your target may be a capital letter written on the back of an index card, or simply your thumb. If you are unable to focus on these, talk with your therapist about modifications.

Let’s get down to exercises.

Eye head movements

• Hold your thumb or index card at arm’s length
• Move your target from side to side and follow it, moving your eyes and head together
• Do this for one minute or your tolerance
• Repeat by following your target up and down

Smooth Pursuit (horizontal and vertical):

• Hold your target out at arm’s length.
• Slowly move it side to side. It should be in a comfortable range for your eyes (no extreme side-eye) and the head should not move.
• This should be done for up to a minute or to your tolerance.
• Repeat the exercise while moving the target up and down.

Saccades (horizontal and vertical):

• For this one you need two targets. Tape them to the wall one foot apart, at eye level.
• Keep your head still and move your eyes from one target to the other. This is the main motion you use to read to jump from one word to the next. Keep moving your eyes from one target to the other as quickly as possible.
• This should be done for up to a minute or your tolerance.
• Repeat this exercise with the letters placed on the wall vertically, 6 inches above and below your eye line.

Gaze Stabilization (horizontal and vertical)

• For this exercise you move your head while keeping your eyes focused. Hold your target out in front of you at arm’s length.
• Turn your head side to side while keeping your eyes focused on your target.
• This should be done as quickly as possible without any neck pain or dizziness.
• Do this for one minute or your tolerance.
• Repeat the exercise by nodding your head up and down while focusing on your target.

Pencil push-ups

• Hold a pencil at arms length out in front of you.
• Slowly bring it in towards your nose. If you have something called convergence deficiency, your eyes will not be able to work together and you’ll start to see two images of the pencil. Stop as soon as this happens, or you get about 2 inches away from your nose. Pause and try to focus your eyes.
• Return the pencil back out to arms length.
• Take a brief few second rest and repeat 10 times.

If you can complete each exercise easily for 60-90 seconds, you may be able to progress them by increments.  If tolerable, you can use a smaller target like a pencil, perform them at a faster pace, or introduce a mental task like coming up with an animal for each letter of the alphabet as you do your eye exercises. Remember, stop if your symptoms increase quickly, give yourself rest time afterwards to let your eyes recover, and keep your care team aware of how you are feeling.