TBI

So it is hard to imagine why there would be a connection between symptoms of dry eyes and head injury. Many of my traumatic brain injury (TBI) patients complain of ocular irritation, redness, and foreign body sensation after head injury. In the absence of direct ocular injury, I have found such complaints difficult to assess.

I was surprised to find a recent publication from the British Journal of Ophthalmology from August 2017 confirms the association between dry eyes and TBI. The causal relationship between the two problems is interesting- many patients with concussions are simply more sensitive to visual discomfort. Thus, it is possible that individuals with a previous mild dry eye syndrome become much more aware of a foreign body or scratchy feeling in their eyes.

The importance of this scientifically supported finding is not just interesting, but can effect a person’s quality of life. People with dry eyes suffer. I have written a previous blog on how patients with TBI are more sensitive to light. Well, people with dry eyes are also more sensitive to light and this can have a big impact on daily activities such as driving.

Patients with significant head injuries have documented evidence of blinking abnormalities. This connection is simple- patients with TBI blink less frequently and this causes dry eyes. Why they blink less is unclear, but one could imagine a connection between brain injury and automatic blinking- this pathway is probably disrupted.

Individuals with TBI also frequently have altered neurologic facial sensation and the surface of the eyes are innervated by the same nerves that innervate the skin of the face.

The important point in this blog is to not ignore a patient’s actual complaints. Prior to my reading the recent Ophthalmology journal article, I might have partially ignored my TBI patient’s complaint of dryness. But I’m now aware of this association and will treat these patients more aggressively. Even as an experienced ophthalmologist, I continually learn about new associations between head injuries and eye problems.

I believe it is my responsibility to read the literature and bring this information to the public.

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