Rehabilitation following penetrating ocular trauma from hand grenade fragments

Abstract: This case study describes the rehabilitation efforts of a 25-year-old male reserve officer who sustained a penetrating intraocular metallic foreign body (IOFB) injury to his right eye during a military conflict. Penetrating ocular trauma can lead to severe tissue deformities, scarring, permanent visual impairment, and long-term complications like intraocular infection and ocular hypotension. The patient's initial presentation revealed vision loss, pain, irritation, a foreign body sensation, and discomfort in the right eye. Diagnostic imaging confirmed a severe globe rupture, including the presence of metallic IOFB in the retina, retinal incarceration, and detachment with severe macular damage, necessitating surgical intervention, including repair of globe rupture, lensectomy, pars plana vitrectomy, IOFB removal, and filling of the vitreous cavity with silicone oil. Despite these surgical measures, visual acuity in the right eye remained hand motion at 15 cm with maintained peripheral vision and traumatic ptosis. A specialized scleral contact lens was fitted. This improved acuity to 6/60 additionally provided a magnifying effect, clinically improving near vision acuity to 6/30. The scleral lens improved the patient's dry eye indices, evidenced by decreased corneal staining and increased margin-to-reflex distance, improving esthetics. This case highlights the potential benefits of a scleral contact lens after severe penetrating eye injuries where even advanced surgical interventions may not fully restore vision. It significantly improved visual function and comfort by alleviating dry eye symptoms and simultaneously provided psychosocial benefits by masking cosmetic imperfections.