Two kids bang heads in a soccer game. A teenager falls awkwardly and hits her head in a gymnastics meet. A boy playing football complains of headaches after the game.

Concussions—mild traumatic brain injury caused by a blow to the head—are a common occurrence in youth sports. This isn’t entirely surprising, since young brains are especially susceptible to injury. 

In fact, sports-related concussions account for more than half of all emergency room visits by children ages 8 through 13, according to a statement by the National Athletic Trainers’ Association.

But if it’s your kid, this is not about statistics. It’s about your child, and concussions are scary. What many parents don’t know: Some of the most persistent—and commonly missed—concussion-related problems have to do with your child’s vision.

First, the good news: Most children who suffer concussions recover in a couple of weeks. But about one in four aren’t so lucky.

“When those patients are examined at three or four weeks after the injury, we find a very high prevalence of vision problems,” says optometrist Mitchell Scheiman, O.D., Ph.D., a Salus University educator and researcher who studies concussions. In fact, in one of his studies, a stunning 69 percent of adolescents in a concussion program were diagnosed with one or more vision problems.

These kids may have trouble returning to school, due to symptoms such as eyestrain, headaches, blurry vision, and trouble concentrating, Dr. Scheiman says. The symptoms can sideline a child for weeks, months, or, in the most extreme cases, even years. 

“Kids can’t go back to school. They can’t go back to play. It prevents them from recovering,” he says.

A blow to the head can disrupt the connections that allow a brain to operate with clarity. This often impacts pathways that affect vision.

“About 50 percent of the neurons in the cortex are related to vision,” says Dr. Scheiman. “So when you start shaking the brain, it’s pretty likely that some of them will be affected.” 

Still, a vision assessment is often neglected following a concussion. Many physicians may not recognize the problem as a visual one. And even if parents do book an eye exam, eye doctors have not always conducted the proper tests to diagnose and treat concussion-related problems.

Fortunately, that’s starting to change, Dr. Scheiman says. With concussions gaining more media and medical attention in recent years, more physicians are performing simple tests to probe for eye problems in post-concussion patients. 

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The best approach: If you suspect that your child has suffered a concussion, seek medical care right away. If symptoms still persist two to four weeks later, make an appointment with your optometrist for testing. 

Be sure to share your concerns with the eye doctor and request a complete evaluation of binocular vision, accommodation, and eye movements. And watch for these vision-related symptoms:

Symptom #1: Trouble Reading or Concentrating

If your post-concussion child struggles with near work like reading, it could signal a convergence issue—or specifically, a condition known as convergence insufficiency, in which the eyes can see fine but aren’t working together as a team. 

As a result, one eye may turn outward instead of inward during near tasks, causing blurry or double vision. This condition may occur in half of post-concussion adolescents who do not recover in two to four weeks, Dr. Scheiman’s research suggests. 

Prism glasses may help, says Elizabeth Walsh Czirr, O.D., F.A.A.O., an optometrist with Nashville Regional Eyecare, located inside an America’s Best. The special lenses align images to suit the eyes, fooling the brain into thinking the eyes are aligned.

But your child will likely need vision therapy too, designed to help retrain the brain to work with the eyes, Dr. Czirr says. Your optometrist may perform vision therapy or refer you to a therapist. “Ideally, you get better at it over time, as some of those lost brain connections are relinked,” says Dr. Czirr. 

The therapy may last for a few months, and Dr. Scheiman’s research shows that vision therapy can bring remarkable results, leading to a successful outcome in about 75 percent of children. 

Symptom #2: Headaches and Eye Strain

Does your post-concussion child complain of headaches and tired eyes? He could be straining to see clearly because of an accommodative disorder—in which it takes unusually long for the eyes to adjust focus to see objects at varying distances. It’s another highly prevalent condition after a concussion. 

Reading glasses or bifocals may help alleviate eye strain, says Dr. Czirr. And again, vision therapy can help. In one simple therapy procedure, the child alternates looking at a small chart up close and a larger chart far away, Dr. Czirr says. This helps train the accommodative system to shift focus more efficiently.

Symptom #3: Dizziness and Nausea

Head trauma can damage the systems that control eye movements, causing the eyes to jump around slightly and making it difficult to track words smoothly across a page, says Dr. Czirr.

As a result, the brain may receive abnormal signals, tricking it into thinking the head is moving when it’s not. This can trigger feelings of imbalance, dizziness, and nausea. Glasses or vision therapy may help.

Symptom #4: Sensitivity to Light

Sometimes a lowered tolerance to light may be a side effect of the additional stress on your child’s eyes and brain, says Dr. Czirr.

Your eye doctor may provide tinted glasses to ease the discomfort. Often, blue- or purple-tinted lenses reduce glare while maintaining good contrast for proper vision, she says. 

Spending some quiet time in a dark room can help too. “You want an unstimulating environment so the brain can focus on healing,” she says.

Symptom #5: Floaters, Light Flashes, or Vision Loss

Head trauma can weaken your retina, the light-sensitive tissue lining the inside of your eye. The retina can tear or even peel away completely, a serious problem known as retinal detachment. That results in blurry vision, and in serious cases can lead to surgery—and in the most extreme cases, even blindness.

If your child experiences floaters, light flashes, or vision loss following a head injury, be sure to schedule a comprehensive eye exam with pupil dilation so your eye doctor can look for holes, tears, or detachments.