Smooth pursuit eye movements are a key component of oculomotor function and frequently disrupted following a concussion. These eye movements allow the eyes to accurately track a slowly moving object — and when impaired, they can cause symptoms like dizziness, nausea, blurred vision, and difficulty reading.

This shortened article explores the importance of smooth pursuit in concussion assessment and recovery, how it’s measured, and what the research says about its role in persistent symptoms. To read the full deep-dive, check Erin Shapcott’s take here.

 

What Are Smooth Pursuit Eye Movements?

Smooth pursuits are slow, coordinated eye movements that allow you to follow moving objects. Unlike quick saccadic movements (used to jump between points), smooth pursuits help maintain stable vision on objects in motion — like a ball flying through the air or text moving across a screen.

After a concussion, these movements may become jittery, delayed, or asymmetrical, leading to a breakdown in visual processing (1). This can contribute to symptoms such as:

  • Eye strain
  • Headaches
  • Visual fatigue
  • Motion sensitivity
  • Difficulty concentrating

Recent data suggest that smooth pursuit deficits are highly prevalent in adolescents and young adults with persistent symptoms (2). These oculomotor dysfunctions are frequently missed during routine assessments, despite their strong correlation with longer recovery times.

 

How Are They Assessed?

Smooth pursuits can be tested clinically through:

  • Visual tracking tests (e.g., following a clinician’s finger or penlight)
  • Vestibular/Ocular Motor Screening (VOMS) — a validated clinical tool used to identify oculomotor and vestibular deficits post-concussion (3)
  • Computerized eye tracking systems — providing quantitative data on accuracy, latency, and movement symmetry

In VOMS, symptom provocation during smooth pursuit tasks — particularly increases in dizziness or nausea — has been associated with protracted recovery, and symptom severity during this test correlates with dysfunction in other visual-vestibular domains (4).

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What the Research Says

Smooth pursuit deficits are part of a broader set of visual dysfunctions that are frequently observed in patients with post-concussion syndrome. Heitger et al. demonstrated that patients with even mild TBI showed impairments in oculomotor control and coordination long after the initial injury (5).

Leddy et al. (2022) found that early identification and treatment of visual and vestibular system dysfunction — including smooth pursuit impairments — was associated with faster recovery following sport-related concussion (6). Delays in assessment were linked to longer symptom duration and reduced functional outcomes.

Furthermore, visual tracking deficits have been linked to postural instability and impaired balance, as smooth pursuits also contribute to the integration of visual-vestibular information (7).

 

Treatment Approaches

If smooth pursuit dysfunction is identified, treatment should include targeted oculomotor rehabilitation. This is typically led by a neuro-optometrist, physiotherapist, or trained concussion specialist and may involve:

  • Tracking exercises using light targets, apps, or computerized tools
  • Head/eye coordination tasks (e.g., moving head while eyes follow a target)
  • Gaze stabilization drills to improve dynamic visual clarity
  • Dual-tasking activities to challenge cognitive-motor integration

These treatments are most effective when integrated with broader vision and vestibular rehabilitation strategies. Patients receiving personalized rehab targeting smooth pursuit have shown faster resolution of symptoms and better return-to-learn and return-to-sport outcomes (8).

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Why It Matters

Visual dysfunctions like impaired smooth pursuit are not only common, they’re also highly modifiable with the right approach. Failing to assess or treat these issues may leave patients struggling with symptoms for weeks or months unnecessarily.

Early, accurate screening — followed by system-specific rehabilitation — is essential.

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References:

Akhand, O., Balcer, L. J., & Galetta, S. L. (2019). Assessment of vision in concussion. Current Opinion in Neurology, 32(1), 68–74.

Armstrong, R. A. (2018). Visual problems associated with traumatic brain injury. Clinical and Experimental Optometry, 101(6), 716-726.

Fox, S. M., Koons, P., & Dang, S. H. (2019). Vision Rehabilitation After Traumatic Brain Injury. Physical Medicine and Rehabilitation Clinics of North America, 30(1), 171-188.

Giza, C. C., & Hovda, D. A. (2014). The new neurometabolic cascade of concussion. Neurosurgery, 75(4 Suppl.), S24-S33.

Hunfalvay, M., Murray, N. P., Mani, R., & Carrick, F. R. (2021). Smooth pursuit eye movements as a biomarker for mild concussion within 7-days of injury. Brain Injury, 35(14), 1682–1689.

Kaae, C., Cadigan, K., Lai, K., & Theis, J. (2022). Vestibulo-ocular dysfunction in mTBI: Utility of the VOMS for evaluation and management – A review. NeuroRehabilitation, 50(3), 279-296.

Master, C. L., et al., (2022). Vision and Concussion: Symptoms, Signs, Evaluation, and Treatment. Pediatrics, 150(2).

Murray S.A., Galetta K.M., Liu J., Brody D.L., 2019. Smooth Pursuit and Saccades After Sport Related Concussion, Journal of Neurotrauma 37(2):191–199.

Waddington, G. S. (2017). The King-Devick Test and concussion diagnosis. Journal of Science and Medicine in Sport, 20(8), 707. doi: 10.1016/j.jsams.2017.06.009.

Whelan, B. M., Gause, E. L., Ortega, J. D., Mills, B. M., Schmidt, J. D., Kaminski, T. W., Buckley, T. A., … Chrisman, S. P. D. (2022). King-Devick testing and concussion recovery time in collegiate athletes. Journal of Science and Medicine in Sport, 25(11), 930-934.