Vision Rehabilitation After Stroke: How to Improve Eye Function

After a stroke, it's common to experience changes in your vision. These may include:

• Blurry or double vision
• Loss of visual field
• Uncontrolled eye movements (nystagmus)
• Dizziness
• Difficulty understanding what you see

These changes can significantly affect your quality of life and daily function. But there is hope—targeted eye exercises and vision therapy may help improve visual function. Not everyone will benefit the same way, so it's important to work with a healthcare professional who specializes in visual rehabilitation to develop a program tailored to your needs.

Blurry or Double Vision

Blurry or double vision (diplopia) is common after a stroke and often results from weakened eye muscles. Normally, both eyes work together to focus on the same point—a process called convergence. If one eye lags or drifts due to muscle weakness, your brain receives two different images, which results in double or blurry vision. This can affect both near and distance vision, making everyday activities such as reading, eating, driving, or walking more difficult.

What Can Help Double Vision?

Patching or Occlusion:  Covering one eye—using an eye patch or opaque tape on glasses—can temporarily reduce double vision, but it doesn’t strengthen weak eye muscles.

Convergence Exercises:  These exercises can improve control and coordination of your eye muscles:

Pencil Push-Ups

• Hold a pencil vertically at arm’s length, aligned with the bridge of your nose.
• Slowly move it toward your nose while keeping the image clear and single.
• Stop if it becomes blurry or doubles, then hold that position.
• Return the pencil to arm’s length and repeat 10–15 times, 2–3 times daily.

Brock String Exercise

• Use a string (10–15 feet) with beads at various intervals.
• Hold one end to your nose, and focus on each bead in turn.
• Try to see one bead with two strings forming an “X” shape.
• Repeat several times.

Dot Card Exercise

• Draw a line of evenly spaced dots on an index card.
• Hold the card to your nose, focusing on each dot one at a time.
• Ensure each dot appears single as you move outward.

Prism Lenses:  If exercises are not effective, a prism lens in your glasses may help realign images, reducing strain and improving clarity. However, prisms can cause side effects like dizziness or visual distortion, so use should be supervised by a trained provider.

Loss of Visual Field

Your visual field is everything you can see around you. A stroke may result in visual field loss, often affecting the same side of both eyes—called homonymous hemianopia. You may lose sight of the left or right half of your surroundings.  This can make daily tasks challenging, such as:

• Walking without bumping into obstacles
• Reading or working at a desk
• Watching TV or using a computer

What Can Help Loss of Visual Field?

Compensatroy Techniques: Some improvement may occur naturally as the brain heals. However, if vision doesn’t return, therapy can teach you how to compensate.  An occupational therapist can help you improve your awareness of the missing side using compensatory techniques such as:

• Head-turning strategies
• Environmental scanning
• Lighting and contrast enhancements 

Peripheral Vision Exercises:  In addition to compensatory techniques, specific eye movement exercises can help to increase your field of view.

Peripheral Vision Training:

• Sit and focus on a central point.
• Without moving your eyes, notice shapes or movements in your peripheral vision.
• Practice for 5–10 minutes daily.

Eye Movement Training:  These exercises widen your visual awareness

• Side-to-Side Glances:  Hold arms out wide, thumbs up. Look left and right using only your eyes. Repeat 10 times.
• Up and Down Glances: Look straight ahead, then up, then down—without moving your head. Repeat 10 times.
• Diagonal Glances: Imagine a square. Look between opposing corners (e.g., top right to bottom left). Repeat 10 times.
• Circular Tracking: Extend your thumb in front of you and draw large circles, following the motion with your eyes.
• Figure Eight: Trace a large figure-eight in the air with your thumb, following with your eyes.

Prism Lenses for Visual Field Loss:  Some people benefit from special prism lenses that shift the visual field, making it easier to see the affected side. Because they can affect depth perception and balance, training with an occupational therapist is essential when using these lenses.

Uncontrolled Eye Movements (Nystagmus)

Nystagmus involves involuntary, repetitive eye movements that can impair your ability to focus and maintain balance. It often leads to:

• Dizziness
• Visual fatigue
• Trouble focusing on objects
• Difficulty riding in cars or navigating busy environments

What Can Help Nystagmus?

These symptoms may improve over time. If not, specialized therapy can help reduce discomfort and improve control. Helpful exercises include:

Eye Tracking:

• Sit comfortably with a pen held in front of you.
• Move it left and right, up and down.
• Follow with your eyes only—no head movement.
• Gradually increase speed as tolerated. Practice for 5–10 minutes daily.

Gaze Stabilization:

• Focus on a fixed target.
• Keep your eyes on it for as long as possible without shifting.
• Gradually increase the duration over time.

Therapists trained in visual-vestibular therapy—including occupational therapists, physical therapists, and neuro-optometrists—can guide you through appropriate exercises to reduce symptoms of nystagmus. 

Final Thoughts

Vision changes after a stroke can be frustrating and even dangerous if left unaddressed. The good news is that with proper assessment and a personalized rehabilitation plan, many people experience meaningful improvements in their vision and overall function. 

If you're experiencing any of these vision changes after a stroke, it's important to consult with a neurologist, occupational therapist, or neuro-optometrist who specializes in post-stroke visual rehabilitation. The occupational therapists at Therapy Achievements are experienced in low vision therapy and are here to help you regain your confidence and independence.

How to Get Started

If you or a loved one could benefit from low vision services, ask your healthcare provider to fax a referral to 800-317-4728, or contact Therapy Achievements directly at 256-509-4398 to learn more.

With the right support, you can retrain your brain—and your eyes—to see and live better.