Eye tracking detects disconjugate eye movements associated with structural traumatic brain injury and concussion

Uzma Samadani, Robert Ritlop, Marleen Reyes, Elena Nehrbass, Meng Li, Elizabeth Lamm, Julia Schneider, David Shimunov, Maria Sava, Radek Kolecki, Paige Burris, Lindsey Altomare, Talha Mehmood, Theodore Smith, Jason H. Huang, Christopher McStay, S. Rob Todd, Meng Qian, Douglas Kondziolka, Stephen WallPaul Huang

Research output: Contribution to journalArticlepeer-review

106 Scopus citations


Disconjugate eye movements have been associated with traumatic brain injury since ancient times. Ocular motility dysfunction may be present in up to 90% of patients with concussion or blast injury. We developed an algorithm for eye tracking in which the Cartesian coordinates of the right and left pupils are tracked over 200sec and compared to each other as a subject watches a short film clip moving inside an aperture on a computer screen. We prospectively eye tracked 64 normal healthy noninjured control subjects and compared findings to 75 trauma subjects with either a positive head computed tomography (CT) scan (n=13), negative head CT (n=39), or nonhead injury (n=23) to determine whether eye tracking would reveal the disconjugate gaze associated with both structural brain injury and concussion. Tracking metrics were then correlated to the clinical concussion measure Sport Concussion Assessment Tool 3 (SCAT3) in trauma patients. Five out of five measures of horizontal disconjugacy were increased in positive and negative head CT patients relative to noninjured control subjects. Only one of five vertical disconjugacy measures was significantly increased in brain-injured patients relative to controls. Linear regression analysis of all 75 trauma patients demonstrated that three metrics for horizontal disconjugacy negatively correlated with SCAT3 symptom severity score and positively correlated with total Standardized Assessment of Concussion score. Abnormal eye-tracking metrics improved over time toward baseline in brain-injured subjects observed in follow-up. Eye tracking may help quantify the severity of ocular motility disruption associated with concussion and structural brain injury.

Original languageEnglish
Pages (from-to)548-556
Number of pages9
JournalJournal of Neurotrauma
Issue number8
StatePublished - 15 Apr 2015
Externally publishedYes


  • concussion
  • cranial nerve palsy
  • disconjugate
  • eye movement tracking
  • ocular motility


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