Whiplash and its effect on the visual system

Abstract

Whiplash or indirect injuries to the neck as a consequence of motor vehicle collisions are a common occurrence in which the frequency of ocular complications is largely unknown. Ophthalmic and oculomotor function was investigated in a longitudinal study of 39 cases who had their initial ophthalmological assessment within one week of the whiplash injury. Ten of 39 cases had ocular symptoms and signs which developed shortly after the accident. The principal abnormality in 6 of these was decreased convergence and accommodation, superior oblique muscle paresis in 2, decreased stereoacuity in 1 and bilateral vitreous detachments in 1 patient. All but 2 had complete resolution of their symptoms within 9 months. Four other patients were asymptomatic but had ophthalmic signs which resolved within 3 months. Oculomotor abnormalities following whiplash injuries are generally mild, have a good prognosis, and would appear from this study to be commoner than hitherto expected.

Accommodation in mild traumatic brain injury

“…Nearly all the patients with mTBI exhibited abnormalities in monocular and/or binocular accommodative amplitude, a basic clinical measure; thus, this measure may represent a potential simple marker for accommodative TBI effects. The presence of accommodative amplitude abnormalities is consistent with, and expands upon, numerous earlier studies [8][9][10][11][12][14][15][16][17]21]. Additionally, a higher percentage of abnormalities were AC/A = accommodative convergence-to-accommodation, eso = esophoria, exo = exophoria, Hyper = hyperphoria, NA = not applicable, NRA = negative relative accommodation, Ortho = orthophoria, PD = prism diopter, PRA = positive relative accommodation, SD = standard deviation, SEM = standard error of the mean.…”

“…This accommodative insufficiency was based on the following diagnostic criteria: the patient was under 35 years of age and complained of blur at near that was reduced with the addition of plus lenses; furthermore, the insufficiency was confirmed with the measurement of a reduced accommodative amplitude and/or positive relative accommodation (PRA) [12]. With regard to whiplash injuries, which can be conceptualized as an "indirect," and perhaps very mild, form of TBI [13], several studies found that approximately 18 to 33 percent of whiplash patients exhibited reduced accommodative amplitude [14][15], while another study showed statistically significant differences (i.e., reduction) in accommodative amplitude between 19 whiplash patients and 43 control subjects using the minus-lens test method [16]. Lastly, a case study reported on a 20-year-old male patient with TBI who exhibited a persistent inability to accommodate in one eye 3 years after the injury [17].…”

Influence of neck torsion on near point convergence in subjects with idiopathic neck pain

“…Nevertheless, people with WAD have previously shown abnormal NPC values in neutral (Burke et al, 1992),. This M A N U S C R I P T…”

“…These tests consider both eyes moving in the same direction, but little consideration has been given to tests examining eyes moving in the opposite direction, for example during convergence (McGregor, 2014). One small study found a greater percentage of convergence abnormalities compared to saccadic and smooth pursuit eye movement abnormalities in those with persistent neck pain following a whiplash injury (WAD) (Burke et al, 1992).…”

Whiplash injuries

“…About a third of patients complain of interscapular and low back pain after whiplash injuries. Patients often report visual symptoms, especially blurred vision, usually due to convergence insufficiency, although oculomotor palsies can occasionally occur [12]. Rare sequelae are listed in Table 1.…”