Vision and Concussion: Symptoms, Signs, Evaluation, and Treatment - Clinical management guidance

Sep 5, 2026

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Vision-specific symptoms commonly follow concussion in children and adolescents, requiring clinicians to screen, identify, and initiate structured clinical management. Most patients recover spontaneously by 4 weeks, but persistent cases need referral to specialists experienced in comprehensive concussion care for further assessment and treatment. A vision-focused history and detailed visual system examination should cover acuity, ocular alignment, tracking, saccades, vestibulo-ocular reflex, and convergence and accommodation.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Background

Clinical relevance of pediatric concussion

Vision and concussion overview

Importance of visual symptom screening

Expected recovery timeline and when to refer

Vision-focused assessment

Vision-specific history

Visual system examination domains

Management and educational accommodations

Early identification of deficits

Support for return to play and school

POLICY STATEMENT Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of all Children Vision and Concussion: Symptoms, Signs, Evaluation, and Treatment Christina L. Master, MD, FAAP,a,b,c Darron Bacal, MD, FAAP,d,e Matthew F. Grady, MD, FAAP,a,c Richard Hertle, MD, FAAP,f,g Ankoor S. Shah, MD, PhD,h,i,j Mitchell Strominger, MD, FAAP,k,l, m, n Sarah Whitecross, MMedSci, CO, i Geoffrey E. Bradford, MD, MS, FAAP,o,p Flora Lum, MD,q Sean P. Donahue, MD, PhD,r AAP SECTION ON OPHTHALMOLOGY; AMERICAN ACADEMY OF OPHTHALMOLOGY; AMERICAN ASSOCIATION FOR PEDIATRIC OPHTHALMOLOGY AND STRABISMUS; and AMERICAN ASSOCIATION OF CERTIFIED ORTHOPTISTS Visual symptoms are common after concussion in children and adolescents, making it essential for clinicians to understand how to screen, identify, and initiate clinical management of visual symptoms in pediatric patients after this common childhood injury. Although most children and adolescents with visual symptoms after concussion will recover on their own by 4 weeks, for a subset who do not have spontaneous recovery, referral to a specialist with experience in comprehensive concussion management (eg, sports medicine, neurology, neuropsychology, physiatry, ophthalmology, otorhinolaryngology) for additional assessment and treatment may be necessary. A vision-specific history and a thorough visual system examination are warranted, including an assessment of visual acuity, ocular alignment in all positions of gaze, smooth pursuit (visual tracking of a moving object), saccades (visual fixation shifting between stationary targets), vestibulo-ocular reflex (maintaining image focus during movement), near point of convergence (focusing with both eyes at near and accommodation (focusing with one eye at near because any of these functions may be disturbed after concussion. These deficits may contribute to difficulty with returning to both play and the learning setting at school, making the identification of these problems early after injury important for the clinician to provide relevant learning accommodations, such as larger font, preprinted notes, and temporary use of audio books. Early identification and appropriate management of visual symptoms, such as convergence insufficiency or accommodative insufficiency, may mitigate the negative effects of concussion on children and adolescents and their quality of life. abstract aDepartment of Pediatrics, University of Pennsylvania Perelman School of Medicine; bMinds Matter Concussion Program, and cPediatric and Adolescent Sports Medicine, Division of Pediatric Orthopaedics, Karabots Center, Children ’s Hospital of Philadelphia, Philadelphia, Pennsylvania; dDepartment of Ophthalmology and Visual Science, Yale University, New Haven, Connecticut; eEye Physicians and Surgeons, PC, New Haven, Connecticut; fDepartment of Surgery, College of Medicine, Northeast Ohio Medical College, Rootstown, Ohio; gDepartment of Specialty Medicine, Ohio University College of Osteopathic Medicine, Athens, Ohio; and Akron Children ’s Hospital Vision Center, Akron, Ohio; hDepartment of Ophthalmology, Harvard Medical School, Boston, Massachusetts; iDepartment of Ophthalmology, Boston Children ’s Hospital, Boston, Massachusetts;jMassachusetts Eye and Ear, Boston, Massachusetts; kDepartments of Surgery, lOphthalmology, mPediatrics, and n Clinical Internal Medicine, University of Nevada Reno School of Medicine, Renown Medical Center, Reno, Nevada; oDepartments of Ophthalmology and pPediatrics, West Virginia University, Morgantown, West Virginia; qQuality and Data Science Division, American Academy of Ophthalmology, San Francisco, California; and rDepartment of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Monroe Carell Jr Children ’s Hospital at Vanderbilt, Nashville, Tennessee This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors h

FAQs

Why are vision symptoms important after concussion in children and adolescents?

Visual symptoms are common after concussion, and clinicians need to screen and identify them to start appropriate clinical management. Early recognition helps reduce functional impact.

When should clinicians refer a child to a specialist after concussion?

Most children recover by 4 weeks, but those without spontaneous recovery may require referral to a specialist experienced in comprehensive concussion management for additional assessment and treatment.

What components should be included in a vision-focused examination after concussion?

The evaluation should include visual acuity, ocular alignment in different gaze positions, smooth pursuit, saccades, the vestibulo-ocular reflex, and near point of convergence and accommodation.

Sep 5, 2026

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