Afferent visual manifestations of traumatic brain injury

Noor Haziq Saliman, Antonio Belli, Richard Blanch

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Traumatic brain injury (TBI) causes structural and functional damage to the central nervous system including the visual pathway. Defects in the afferent visual pathways affect visual function and in severe cases cause complete visual loss. Visual dysfunction is detectable by structural and functional ophthalmic examinations that are routine in the eye clinic, including examination of the pupillary light reflex and optical coherence tomography (OCT). Assessment of pupillary light reflex is a non-invasive assessment combining afferent and efferent visual function. While a assessment using a flashlight is relatively insensitive, automated pupillometry has 95% specificity and 78.1% sensitivity in detecting TBI-related visual and cerebral dysfunction with an area under the curve of 0.69-0.78. OCT may also serve as a noninvasive biomarker of TBI severity, demonstrating changes in the retinal ganglion cell layer and nerve fiber layer throughout the range of TBI severity even in the absence of visual symptoms. This review discusses the impact of TBI on visual structure and function.

Original languageEnglish
Pages (from-to)2778-2789
Number of pages12
JournalJournal of Neurotrauma
Issue number20
Early online date16 Jul 2021
Publication statusPublished - 12 Oct 2021

Bibliographical note

Publisher Copyright:
© 2021, Mary Ann Liebert, Inc., publishers.


  • adult brain injury
  • assessment tools
  • degeneration
  • ganglion cell layer
  • head trauma
  • optical coherent tomography
  • retinal nerve fiber layer
  • traumatic brain injury
  • traumatic optic neuropathy
  • visual function


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