Vestibulo-Ocular Dysfunction Following Sports-Related Concussion: Assessment And Rehabilitation Strategies - a Narrative Review

Background. Vestibulo-ocular dysfunction is among the most common and functionally consequential sequelae of sport-related concussion (SRC), affecting eye-tracking, gaze stability, balance, and visual processing through disruption of an anatomically distributed neural network spanning brainstem, cerebellar, and cortical structures.Aim. To synthesise, from a clinically oriented and critical perspective, the mechanisms, assessment tools, diagnostic accuracy, prognostic value, and rehabilitation strategies for vestibulo-ocular dysfunction after SRC.Materials and Methods. Narrative review of peer-reviewed English-language consensus statements, systematic reviews, randomised controlled trials, prospective cohorts, retrospective series, and mechanistic and neuroimaging studies addressing vestibular, oculomotor, and cervicogenic dysfunction after sport-related concussion.Results. Vision or vestibular problems affect a substantial majority of children in specialist concussion clinics, with lower but still considerable prevalence in unselected athlete cohorts. Convergence insufficiency, saccadic dysfunction, and vestibulo-ocular reflex impairment predominate. The Vestibular/Ocular Motor Screening and King-Devick test add diagnostic value but are not individually sufficient, and accuracy declines with time since injury. Oculomotor and vestibular symptom provocation predicts protracted recovery. Sub-symptom-threshold aerobic exercise and cervicovestibular rehabilitation have randomised support; targeted vestibular and vision therapies show consistent but methodologically heterogeneous benefit.Conclusions. Structured multidomain vestibulo-ocular assessment should be embedded in concussion pathways beyond the acute window, with early referral for targeted rehabilitation when deficits are identified, rather than reliance on symptom report or rest alone.