When your child takes a hit to the head on the field or court, it’s natural to look for signs that something isn’t quite right. One thing we commonly hear from concerned parents or bystanders is, “His/Her eyes look weird—he or she must have a concussion.”

What exactly are we looking for in the eyes when we examine your child and what do those signs really mean to us? Let’s clear things up.

It’s true that changes in the eyes can be part of a concussion evaluation. Athletic trainers and medical professionals often check the pupils during a head injury assessment—but not just to decide if a concussion is present. Eye checks can also help rule out more serious issues, like a brain bleed, eye injury, or nerve damage.

Pupil size, reaction to light, and eye movement are all part of what we take a look at. But here’s the key: concussions don’t always cause changes in the eyes, and when they do, it’s often subtle—something only trained eyes may notice.

Pupil Size: One Clue, Not a Diagnosis

People often think dilated (big) or constricted (small) pupils automatically mean a concussion. But the truth is, pupils can change for lots of reasons—lighting, stress, certain medications, or other medical conditions. Even in a concussion, pupils can still appear perfectly normal. Something to keep in mind is that when we examine someone’s pupils related to a suspected head injury, it may be the first time we’ve taken notice to their pupils. We don’t know if some minor irregularities are normal for the person.

That said, here’s what parents should know about possible changes:

🔍 Dilated Pupils (Big Pupils)

Dilated pupils can sometimes occur after a concussion due to disruption in the brain’s control over the nervous system. (Remember: a concussion is a functional injury; not a physical injury!) Concussions can throw off the part of the nervous system that controls how the pupils respond to light and regulate stress. This might lead to pupils staying larger than normal or reacting more slowly.

Other possible reasons for dilated pupils after a head injury include:

• Increased light sensitivity (a common concussion symptom)
• Visual or balance issues linked to the brain’s ability to control eye movement
• Emotional or physical stress right after the hit

Keep in mind, if only one pupil is dilated and the other isn’t responding, that’s a red flag for something more serious and not typical of a simple concussion. We’ve got to act fast in that situation!

🔍 Constricted Pupils (Small Pupils)

This is less common in concussion cases, but still within the range of possibility. A concussion may disrupt the nervous system in a way that triggers the parasympathetic (calming) side to become overactive, leading to smaller-than-normal pupils. Constricted pupils may also result from:

• Stress or fatigue
• Certain medications (like opioids or nausea meds)
• Deeper brain involvement in more severe injuries

Just like with dilation, pupil constriction isn’t a reliable sign of concussion by itself—but it’s one more data point we use to paint the full picture of what’s occurring.

More Than Meets the Eye

During a proper head injury evaluation, we look at how the eyes move too. Can the athlete track an object smoothly? Do they feel dizzy or nauseous when moving their eyes? Are their eyes jumping or having trouble focusing? These things can give us important clues—not only about concussions but also about possible vestibular (balance-related) or visual tracking issues that can affect recovery.

What Parents Should Know

As a parent, you don’t need to be an expert in pupil reactions—but you can be a calm, informed observer. If your child takes a hit to the head and you’re concerned, look for the big-picture symptoms:

• Headache
• Confusion or trouble answering questions
• Dizziness or balance issues
• Sensitivity to light or noise
• Nausea
• Behavior or personality changes

And yes, if something about the eyes looks “off” to you—go ahead and mention it. Just know it’s one piece of a much larger puzzle.

Bottom Line

When evaluating a head injury, eye checks matter—just understand they’re not the magic test to confirm or deny a concussion. They help athletic trainers and medical professionals assess overall brain function and rule out other concerns. So the next time someone says, “He has a concussion—look at his eyes,” you’ll know there’s much more to the story.

As always, if we can assist in any way or answer any of your concussion-related questions, feel free to reach out to us at Country House Athletics at any time!