Differential diagnosis and theories of pathophysiology of post-traumatic photophobia: A review

Issue title: Visual Disturbances in Acquired Brain Injury

Guest editors: Jacqueline Theis

Article type: Review Article

Authors: Theis, Jacqueline^{a; b}

Affiliations: [a] Concussion Care Centre of Virginia, Richmond, VA, USA | [b] Virginia Neuro-Optometry, Richmond, VA, USA Tel.: +1 804 387 2902; Fax: +1 804 509 0543; E-mail: drtheisod@virginianeurooptometry.com

Abstract: BACKGROUND:Photophobia is a common sensory symptom after traumatic brain injury (TBI) that may have a grave impact on a patient’s functional independence, neurorehabilitation, and activities of daily living. Post-TBI photophobia can be difficult to treat and the majority of patients can suffer chronically up to and beyond one year after their injury. OBJECTIVES:This review evaluates the current theories of the pathophysiology of photophobia and the most-common co-morbid etiologies of light sensitivity in TBI to help guide the differential diagnosis and individualized management of post-TBI photophobia. METHODS:Primary articles were found via PubMed and Google Scholar search of key terms including “photophobia” “light sensitivity” “photosensitivity” “photo-oculodynia” “intrinsically photosensitive retinal ganglion cells” “ipRGC” and “concussion” “brain injury” “dry eye”. Due to paucity of literature papers were reviewed from 1900 to present in English. RESULTS:Recent advances in understanding the pathophysiology of photophobia in dry eye and migraine and their connection to intrinsically photosensitive retinal ganglion cells (ipRGC) have revealed complex and multifaceted trigeminovascular and trigeminoautonomic pathways underlying photophobia. Patients who suffer a TBI often have co-morbidities like dry eye and migraine that may influence the patient’s photophobia. CONCLUSION:Post-traumatic photophobia is a complex multi-disciplinary complaint that can severely impact a patient’s quality of life. Exploration of underlying etiology may allow for improved treatment and symptomatic relief for these patients beyond tinted lenses alone.

Keywords: Photophobia, photosensitivity, light sensitivity, traumatic brain injury, TBI, ipRGC, concussion

DOI: 10.3233/NRE-228014

Journal: NeuroRehabilitation, vol. 50, no. 3, pp. 309-319, 2022