Ocular Trauma: Vision Loss in Vets with Traumatic Brain Injury

Each war leaves its own brand of trauma on soldiers.

Amputation was the most common surgery during the American Civil War. World War I brought mustard gas and an epidemic of scarred lungs.

For veterans returning from war in Iraq and Afghanistan, vision problems caused by traumatic brain injury are a growing concern. These veterans have better body armor than soldiers in the past, but they are more likely to be severely shaken by a blast from a homemade explosive device.

About 16% of soldiers who fought in Iraq have returned with vision problems, often due to a traumatic brain injury. In comparison, 9% of Vietnam soldiers and 6% of World War II soldiers had eye injuries.

The New Ocular Trauma: Closed-Eye Injuries

Blunt force can hurt the eye without piercing it. These ''closed-eye injuries'' are difficult to diagnose because there's no obvious injury to the outside of the eye. But inside, blunt force can damage the cornea, retina, lens, and optic nerves. Sometimes, vision problems from ocular trauma don't show up for one to three years after the blast. As a result, veterans may not know that they have eye damage until they have an eye exam or start having vision problems after they've left military service.

Symptoms of Ocular Trauma

There are a variety of visual problems that can occur at different time points in your recovery. There can also be a complete loss of sight in one or both eyes, depending on the injury. Some of the most common types of vision problems include the following:

Screening for Vision Loss

A simple eye chart test cannot always diagnose ocular trauma. Veterans may still be able to see well, although they have other visual symptoms. More thorough vision screenings are needed for veterans with traumatic brain injury. All soldiers at Walter Reed Army Medical Center who have had traumatic brain injury within two years now have screenings for vision loss. The Center's staff found that 64% of these soldiers have vision problems.

Other veteran rehabilitation centers are also screening for low vision in soldiers who have had a traumatic brain injury. (Low vision is sight impairment that eyeglasses, contact lenses, surgery, or medicine can't fix.) Tests revealed that these soldiers had mild to severe vision problems. And 2% of them were legally blind.

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Expanding Vision Services for Veterans

More than one million U.S. veterans -- of all ages and from all wars -- are legally blind or have low vision. The Department of Veterans Affairs has been expanding services for these veterans.

Eye care specialists at intermediate low vision clinics help veterans use the vision they have. Therapy may include positioning devices and special lighting. The aim is to aid veterans in reading, writing, finding signs, cooking, and managing medicines. Advanced low vision clinics help veterans move around and find their way independently. Specialists also help these veterans use their hearing and other senses more effectively, which can be very helpful when traveling.

Getting Help for Vision Loss and Ocular Trauma

Contact a Veterans Affairs (VA) clinic if you are a veteran who has been in a blast and you have any symptoms of vision loss. There are inpatient programs for serious and complex cases at polytrauma rehabilitation centers. Outpatient rehab at polytrauma network sites may help if your case is less severe. Know that you are not alone, and help is available.

WebMD Medical Reference Reviewed by Alan Kozarsky, MD on April 25, 2016

Sources

SOURCES:

BrainLine.org

Cockerham, G. The New England Journal of Medicine, June 2, 2011.

Cockerham, G. Journal of Rehabilitation Research & Development, 2009.

American Academy of Ophthalmology.

National Alliance for Eye and Vision Research: "Through the Eyes of a Soldier: A Congressional Briefing on Combat Related Eye Injuries."

Lighthouse International: Charles Bonnet Syndrome.

News release, American Society of Cataract and Refractive Surgery.

National Eye Institute: "Age-Related Macular Degeneration: What You Should Know."

Walter Reed National Military Medical Center.

National Library of Medicine, MedlinePlus: "Vision Impairment and Blindness."

U.S. Department of Veterans Affairs: "Blind Rehabilitation Services Outpatient Clinics."

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