Neuro-ophthalmic sequelae of sports-related injuries: mechanisms, diagnosis, and emerging directions

Introduction: Neuro-ophthalmic trauma in sports is an increasingly recognized cause of vision loss, ocular motor dysfunction, and visual processing disorders in athletes. Despite the high incidence of sports-related concussion and craniofacial trauma, the neuro-visual consequences are often underdiagnosed and under-researched. This review fills a critical gap by consolidating clinical, imaging, and management perspectives in a multidisciplinary framework. Areas covered: This review examines the spectrum of neuro-ophthalmic complications arising from sports-related injuries, including mechanisms, clinical manifestations, diagnostic evaluation, and evolving management strategies. It highlights recent advances in optical coherence tomography (OCT), electrophysiology, including visual evoked potentials, and neuroimaging, while also addressing unmet needs in vision rehabilitation, athlete safety protocols, and long-term. Bridging neuro-ophthalmology, trauma medicine, and sports health, this review offers a comprehensive lens on how ocular and neural pathways are impacted across contact and high-velocity sports. Expert opinion: Visual dysfunction is increasingly recognized as a core feature of sports-related traumatic brain injury, emphasizing the need for appropriate neuro-ophthalmic assessment in concussion care. Advances in imaging, eye-tracking technologies, and vision rehabilitation show promise for improving diagnosis, treatment, and monitoring, but widespread adoption is limited by training gaps and a lack of standardization. Emerging protective technologies and objective biomarkers could substantially enhance prevention and return-to-play decisions.