Changes to vision after a stroke

One of the first signs of a Transient Ischaemic Attack (TIA) or stroke can be visual disturbance - loss of vision in one area of the visual field which can be experienced as not being able to see on one side. Another problem can be seeing double. When this was first experienced, people sometimes put it down to a migraine (see 'The event: A stroke or TIA').

Some people found that the visual disturbance recovered a few days after the stroke, however, others found that it persisted for longer with variable severity. The ability to read close up or to see distances were sometimes changed although this was usually temporary. 

Visual field 

There are many types of visual field loss after a stroke, but the most common one is called hormonymous hemianopia. This is when people can only see the right half or the left half of what they are looking at out of each eye. People sometimes said that they had lost vision in one of their eyes after their stroke, however it is more likely that the stroke has affected the visual pathways which travel from one side of both eyes to the brain, rather than damage in the one eye itself.

Visual loss on the right is due to damage to the pathways carrying information from both eyes to the left side of the brain and visual loss on the left is due to damage to the pathways carrying information from both eyes to the right hand of the brain. 

Most people we spoke to had experienced this as a partial loss of their peripheral vision. This could cause problems with things like bumping into door frames, knocking things over or not seeing the first or last part of a sentence when reading. 

Some people found that the loss of peripheral vision could largely be compensated for by turning the head or scanning wider although this tends not to work if the left side of vision is lost.

Loss of visual field often meant that people had to give up driving. Vision is usually assessed using a special test and if the loss is only partial then the person may be allowed to drive.

A woman who had experienced a more severe hemianopia explained that it had been quite difficult to explain to her colleagues, because her eyes looked normal and they assumed that she had lost the vision in just one eye. She worked in a doctor's surgery and one of the doctors put some elastoplasts over one side of a pair of glasses so other people could experience what it was like.

A man who had severe hemianopia also had some perception problems which caused him to neglect or ignore things on his left hand side.

Double vision 

A less common visual problem after stroke is double vision. This is due to damage in a part of the brain at the back of the head that coordinates the movement of both eyes. A man explained that although the vision in both his eyes was perfect he would see two of everything. He had been provided with special glasses with a frosted lens. He would alternate which eye he used by changing the lens every month.

Sometimes prismatic lenses can be used to correct double vision, however as this man explains the movement of the eyes needs to be coordinated. 

Other visual changes

We spoke to a few people who had experienced less common visual changes following a stroke.

One woman had a range of visual problems including visual field loss and loss of depth perception which made it difficult for her to cross the road and go downstairs. 

Her visual perception and visual memory had also been affected. She struggled to recognise unfamiliar surroundings, found it difficult to follow directions. She also experienced some problems with recognising unfamiliar faces and had some changes in her perception of colour.

The Stroke Association has a leaflet on ‘Visual problems after stroke’ and so do Chest, Heart and Stroke Scotland.

Last reviewed June 2017.
Last updated June 2017.


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