It has been months since the accident. The bruises healed, the CT scan came back clean, and everyone around you assumes you’ve moved on. But you haven’t. The grocery store still makes your head swim. Highway driving leaves you white-knuckled and nauseated. Bright lights feel like an assault, and reading more than a page or two brings on a headache that sits right behind your eyes. You’ve been told it’s anxiety, or inner-ear trouble, or that “it just takes time.” And you’re starting to wonder whether this is simply your life now.
We hear some version of this story in our Garden City office every week. And for many of these patients, the missing piece turns out to be something no one thought to check carefully: how their two eyes are working together.
Why Dizziness After a Concussion Can Linger
A concussion is a mild traumatic brain injury caused by a blow or jolt that makes the brain move rapidly inside the skull. You don’t have to hit your head to get one. The sudden whipping motion of a rear-end collision (often called whiplash) can be enough, which is why dizziness after a car accident is so common even when there was no obvious head injury.
Most people feel better within a few days or weeks. But according to the CDC, some people have symptoms for months or longer, and the agency advises talking with a healthcare provider if symptoms don’t go away within two to three weeks. When they persist, doctors often use the term post-concussive syndrome.
Lingering dizziness can come from several places: the inner ear, the neck, or the brain’s balance centers. These deserve proper evaluation. But the visual system is one of the most frequently overlooked sources, and it’s where our practice focuses entirely.
How a Concussion Can Throw Off Your Eye Alignment
Your brain relies on your two eyes pointing at exactly the same spot so it can fuse two images into one clear, stable picture. That coordination depends on a finely tuned network of eye muscles, nerves, and brain pathways, and an injury can disrupt it.
What Is Binocular Vision Dysfunction?
Binocular Vision Dysfunction (BVD) is a condition in which the eyes are very slightly misaligned, so each one sees an image that sits in a slightly different place. The brain won’t tolerate double vision, so it forces the eye muscles to constantly correct the mismatch. That correction happens all day, every day, and the muscles become overworked and fatigued.
The result isn’t usually obvious double vision. Instead, the strain shows up as symptoms most people would never connect to their eyes: dizziness, nausea, headaches, neck and shoulder pain, anxiety, and trouble concentrating.
Vertical Heterophoria: A Common Post-Concussion Culprit
One specific form of BVD, Vertical Heterophoria (VH), occurs when one eye sits slightly higher than the other. Even a tiny vertical misalignment can be enough to cause the unsteady, floating, or “off-balance” feeling that so many post-concussion patients describe. In some cases, trauma affects a single eye muscle, a condition called Superior Oblique Palsy, which can produce a similar pattern along with a habitual head tilt.
Signs Your Lingering Symptoms May Be Visual
Vision problems after concussion rarely announce themselves as “eye problems.” If you’ve been struggling since an injury, notice whether any of these sound familiar:
- Dizziness or feeling off-balance in busy, visually cluttered places like grocery stores, malls, or parking garages
- Light sensitivity after concussion that hasn’t improved, especially under fluorescent lights or on screens
- Vision that feels blurry, shadowed, “swimmy,” or just hard to describe
- Losing your place while reading, or needing to re-read lines to absorb them
- Headaches around or behind the eyes, or at the forehead and temples
- Neck or shoulder tension, or tilting your head without realizing it
- Motion sickness or discomfort as a driver or passenger, particularly at highway speeds
- Anxiety or feeling overwhelmed in crowds or open spaces
You can review the full list of BVD symptoms on our site. Many of our patients recognize themselves in nearly every line.
Why Standard Eye Exams and Scans Often Miss It
It’s understandable to feel confused when every test comes back “normal.” Here’s why that happens. An MRI or CT scan looks for structural damage to the brain, not for how well the eyes coordinate with one another. A routine eye exam is designed primarily to measure how clearly each eye sees, and you can have perfect 20/20 vision in each eye while the two are still slightly out of sync.
The misalignments involved in BVD are often very small, well below what standard screening is designed to catch. Detecting them takes specialized testing and a practitioner trained to look for them. That’s why so many post-concussion patients spend months or years moving between specialists before anyone considers a visual cause.
What the Research Shows
The connection between head injury and vertical heterophoria is well documented. A study published in the journal PM&R, co-authored by Dr. Debby Feinberg of Vision Specialists of Michigan, looked at 43 traumatic brain injury patients who had been living with persistent post-concussive symptoms for an average of three and a half years, despite standard treatments and medications. After being diagnosed with vertical heterophoria and treated with individualized prismatic lenses, patients reported roughly a 72% reduction in their symptoms.
Dr. Feinberg is the pioneer of NeuroVisual Optometry, and her work is the foundation of how we practice. Dr. Cheryl Berger Israeloff was the first optometrist in New York State to be trained directly by Dr. Feinberg, and she brought that same diagnostic and treatment approach to Long Island when she founded our practice in 2015.
How We Treat Post-Concussion Vision Problems
A Thorough NeuroVisual Evaluation
Your visit begins with a detailed conversation about your injury, your symptoms, and everything you’ve tried so far. From there, we perform specialized testing that measures how your eyes work together, looking for the small horizontal and vertical misalignments that routine exams can miss. Because symptoms can shift as the eyes are corrected, we test carefully and often in stages to find the precise prescription your visual system needs.
Micro-Prism Lenses and TheraLens®
Treatment centers on micro-prism lenses: eyeglass lenses with a precisely measured amount of prism that shifts the image each eye sees, so the two line up without your eye muscles having to strain. When the constant muscle effort stops, the symptoms it was driving often begin to ease, sometimes quite quickly. Our practice also has access to TheraLens®, a customized prism lens technology developed specifically for patients with Binocular Vision Dysfunction.
Dr. Marissa Zimmerman, whom Dr. Israeloff personally trained, has extensive experience caring for post-concussion patients, from adults recovering after a car accident to student athletes working their way back to the classroom and the field. Our treatment works well alongside physical therapy, vestibular therapy, and care from your neurologist; many patients find that once their vision is aligned, their other therapies finally start to make progress. You can see everything we offer on our full range of services page.
Care for Long Island and the New York Metro Area
The Neuro Visual Center of New York is the only full-time neurovisual practice in New York State. Our Garden City office is dedicated entirely to diagnosing and treating Binocular Vision Dysfunction and related conditions, and we see patients from across Nassau County, Suffolk County, New York City, and beyond. We also specialize in visual problems following traumatic brain injury, stroke, and other neurological conditions.
You Don’t Have to Keep Living With It
Persistent dizziness, light sensitivity, and “off” vision months after a concussion or car accident are not something you simply have to accept, and they’re not all in your head. For many people, the answer lies in a subtle eye misalignment that has gone unnoticed since the day of the injury.
If you’re still struggling after a concussion, whiplash, or accident, take a few minutes to complete our BVD Questionnaire; it’s a quick way to see whether your symptoms fit the pattern we treat. You can also call us at (516) 224-4888 to talk with our team. We’d be glad to help you find out whether your eyes are the missing piece.
