When not to give up: restoring vision in a child with no perception of light after ocular trauma

INTRODUCTION

Ocular trauma is an important cause of visual loss in children. Penetrating injuries, especially from vegetative objects, are prone to infection and often carry a poor prognosis, particularly when the child presents with no perception of light (NPL). Despite this, with timely surgical intervention and proper visual rehabilitation, meaningful vision can sometimes be restored. We present a case of severe pediatric ocular trauma with NPL vision at presentation that achieved functional recovery after stepwise management.

CASE REPORT

A 6-year-old female presented 6 days after sustaining a thorn injury to her left eye while playing. She complained of severe pain and loss of vision. Visual acuity (VA) was 6/9 in the right eye and no perception of light (NPL) in the left. Slit-lamp examination revealed a sealed corneal entry wound, 4+ anterior chamber cells and flare, posterior synechiae, and endothelial exudates [Figure 1]. The lens and posterior segment were not visible. Based on the Birmingham Eye Trauma Terminology System, this was a penetrating injury with an ocular trauma score (OTS) of 1.^1,2

Close

Figure 1:

Slit-lamp image showing sealed corneal entry wound with endothelial exudates and severe anterior chamber reaction.

Export to PPT

Intravitreal vancomycin and ceftazidime were administered. B-scan ultrasonography confirmed vitreous opacities consistent with endophthalmitis [Figure 2].³

Close

Figure 2:

B-scan ultrasonography revealing dense vitreous opacities consistent with endophthalmitis.

Export to PPT

Three weeks later, a three-port pars plana vitrectomy (PPV) with lens extraction and fluid–air exchange was performed [Figure 3]. Postoperatively, the child was managed with topical corticosteroids, antibiotics, cycloplegics, and oral corticosteroids. The corneal scar stabilized, and best-corrected visual acuity (BCVA) improved to 6/24 with aphakic correction.

Close

Figure 3:

Intraoperative view of PPV with lens extraction via a three-port approach. PPV: Pars plana vitrectomy.

Export to PPT

At 10 weeks post-injury, a secondary scleral tuck intraocular lens (IOL) (Omnifit +18.0 D) was implanted. The postoperative course was complicated by transient hyphema, which resolved with medical therapy. At final follow-up, 3.5 months post-trauma, BCVA in the left eye was 6/18 with a −1.50 D cylinder at 140°. The corneal scar was stable, and the IOL was well centered [Figure 4].

Close

Figure 4:

Postoperative slit-lamp image showing a stable corneal scar and a well-centered scleral tuck IOL. IOL: Intraocular lens.

Export to PPT

DISCUSSION

Penetrating injuries from vegetative objects such as thorns pose a high risk for infectious complications like endophthalmitis and poor visual outcomes in children.⁴ The OTS predicted minimal visual potential in this case,² yet timely intervention enabled meaningful vision restoration. This outcome aligns with studies showing that aggressive infection control, early vitrectomy, and staged visual rehabilitation significantly improve outcomes even in severe ocular trauma.^3,5

This case reinforces that the NPL vision at presentation should not automatically preclude surgical intervention. Stepwise care, secondary IOL implantation, and visual rehabilitation can restore function even in eyes with dismal prognostic indicators.

CONCLUSION

Severe pediatric ocular trauma complicated by endophthalmitis may initially present with NPL vision and poor prognosis scores. Persistence with structured care can salvage vision, demonstrating the importance of not abandoning such eyes.