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Table 1 Summarisation of the types of injury that follow TBI which may lead to visual dysfunctions and vision impairment

From: Traumatic brain injury and sight loss in military and veteran populations– a review

Injury Features of injury
Outer eye/globe Can be caused by open globe injuries such as perforation, penetration, intraocular foreign bodies and rupture from exposure to blasts
Can also be caused by exposure to peak overpressure from blasts directed at the globe
Inner eye/globe Retinal ganglion cell death can be caused by exposure to high blast pressures, as well as blunt impacts. Retinal ganglion cell death can occur when there is damage to the optic nerve as well. Retinal scarring due to elevated blood pressure and retinal haemorrhaging. This is caused by exposure to high impact force from blast TBI
Optic nerve Optic nerve damage may be direct or indirect
Direct TON is usually caused by penetrating injuries from shrapnel from explosives. Indirect TON is usually caused by blunt impact to the head so there is transfer of distal forces and energy from the forehead to the optic nerve; or exposure to peak overpressure from a blast
Occipital lobe and visual cortex Impact to ventral and dorsal pathways leading from primary visual cortex as a result of mild TBI. TBI directly to the back of the head, or TBI to the front of the head which results in the brain moving back and forth inside the skull may result in occipital lobe damage
  1. TBI traumatic brain injury; TON traumatic optic neuropathy