The Application of Binasal Occlusion in the Treatment of Visual Motion Sensitivity

Abstract

BACKGROUND: A traumatic brain injury (TBI) occurs when there is neurological damage to the brain or spinal cord resulting from an external insult to the head. TBIs can range from mild to severe (severe cases include more serious bruising, extended loss of consciousness, or seizures). In cases of a mild TBI (mTBI) symptoms such as headaches, nausea, photophobia, asthenopia, intermittent diplopia, or blurred vision are often reported. Another common symptom associated with mTBI is nausea and dizziness associated with motion-related tasks such as walking in a busy environment or scrolling an electronic device, known as visual motion sensitivity (VMS). VMS and its associated symptoms often persist for months following the initial brain injury but may be alleviated with appropriate treatment. CASE SUMMARY: KL, a 47-year-old woman, presented for a binocular vision assessment to investigate persistent symptoms consistent with visual motion sensitivity. KL had sustained a mTBI two months prior after falling and hitting her head against her daughter’s head. Throughout the exam, KL reported increased ocular discomfort, headaches, and anxiety with visually stimulating or motion-related testing, including OKN testing and tandem walks. Exam findings showed a reduction in stereopsis and a high lag of accommodation. KL was diagnosed with accommodative insufficiency and visual motion sensitivity secondary to her TBI. She was prescribed in-office vision therapy and binasal occlusion (BNO) to reduce motion stimulation. Application of BNO provided immediate relief of KL’s symptoms associated with VMS. CONCLUSION: Binasal occlusion should be considered an adjunct treatment option in cases of VMS secondary to mTBI in providing patients with immediate relief of visual symptoms associated with activities of daily living.