Concussion frequently disrupts visual pathways, making neuro-ophthalmic assessment critical for both diagnosis and monitoring recovery. The purpose of this case study is to describe what appears to be, after literature searches on PubMed and Google Scholar, one of the first reported cases of post-concussive Horner’s syndrome, as well as oculomotor dysfunction, and to illustrate its resolution using a virtual-reality (VR) neuro-ophthalmic diagnostic platform. 

A 44-year-old man developed frontal-temporal headaches provoked by near-vision tasks—scrolling on phone, reading, and gaming—after a ball struck his face several months earlier. While the patient demonstrated normal best-corrected visual acuity, his initial examination revealed left-eye Horner’s syndrome (upper-lid ptosis, lower-lid “reverse” ptosis, anisocoria with dilation lag) and saccadic intrusions on near-point-of-convergence testing. Ocular health was otherwise unremarkable. 

VR-based neuro-ophthalmic testing showed a comitant eso deviation, left-eye dilation lag without relative afferent pupillary defect, saccadic inaccuracies and corrections, reduced saccadic velocity in down going saccades > up going saccades, saccadic intrusions and endgaze nystagmus during smooth pursuit, mildly inaccurate convergence beyond 5°, and limited divergence (≈1.5°). 

Six months later the clinical signs of Horner’s syndrome had completely resolved, along with some signs of oculomotor dysfunction. Repeat VR testing demonstrated normal pupillary function, more accurate saccades, fewer saccadic intrusions and less endgaze nystagmus on pursuits, improved convergence, and absent divergence fusion; vertical-saccade velocities were unchanged. 

This case demonstrates that Horner’s syndrome can occur as a transient sequela of concussion and may resolve within months. Serial assessment with a VR neuro-ophthalmic platform objectively captured both the presence and the resolution of sympathetic dysfunction as well as broader oculomotor recovery. This helps underscore the technology’s value in the diagnosis and monitoring of concussion and, by extension, more severe traumatic brain injury.