Editor’s Pick: Ocular Manifestations of Whiplash Injury

A topic much discussed within global news, the incidence of whiplash claims has rocketed exponentially over the last decade. However, the severity of whiplash injury for affected individuals remains a cause for concern and should not be overlooked by clinicians, regardless of the circumstances. Ling and Sanjay collate the literature published on ocular damage from 1985–2015 and provide a comprehensive example of the extent to which whiplash can harm an individual, highlighting the importance of a thorough patient evaluation to avoid overlooking ophthalmic indicators of hidden damage that may quickly develop into permanent problems.

Celeste Yong Pei Ling,1 *Srinivasan Sanjay1,2

1. Yong Loo Lin School of Medicine, National University of Singapore, Singapore
2. Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Yishun Central, Singapore
*Correspondence to sanjays@alexandrahealth.sg

Disclosure: The authors have declared no conflicts of interest.
Received: 23.05.16 Accepted: 28.09.16
Citation: EMJ. 2016;1[4]:27-33.


Introduction: Whiplash or indirect injuries to the neck are a common occurrence because of motor vehicle collisions, in which the frequency of ocular complications is largely unknown.

Aim: We aim to review the ocular manifestations, the utility of relevant diagnostic tests, the management, prognosis, and sequelae of whiplash-related ocular complications.

Methods: A comprehensive literature search was conducted on Medline®, PubMed®, Google Scholar™, and Cochrane databases. Only articles published or translated into the English language from 1985–2015 were considered and key data from the full article of each paper were extracted and evaluated.

Results: The authors’ search yielded 41 articles. Blurring of vision was the most common presenting symptom. Other common presenting symptoms included words and objects moving within the visual field as well as difficulty in concentration. Ocular findings involved: disturbed eye movements; vestibulo-ocular reflex and cervico-ocular reflex dysfunction; anterior segment abnormalities such as accommodative and convergence dysfunction and relative afferent papillary defect; and posterior segment abnormalities such as macular oedema and foveal lesions. The treatment for ophthalmic complications of whiplash injuries is mainly conservative and revolves around neck physiotherapy and oculomotor rehabilitation. The prognosis of the ocular injury depends on the ocular findings as well as the interval between whiplash injury and treatment initiation.

Conclusion: Whiplash injuries occur commonly in motor vehicle accidents. While patients may present asymptomatically, a myriad of ophthalmic complications may be detected. Prognosis for ocular complications depends mainly on the severity of complication(s), the time lapse between injury and detection of complication(s), and the initiation of treatment. Ophthalmologists and physicians should be aware and vigilant towards patients following whiplash injury as a small minority of patients may have poor visual outcome and quality of life without treatment and follow-up.

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