Posttraumatic Pseudomyopia Following Severe Brain Injury: A Clinical Case and Vision Rehabilitation Outcomes

Context: Posttraumatic pseudomyopia (PTPM) is a rare but clinically significant visual complication following traumatic brain injury (TBI), often misdiagnosed as progressive myopia due to accommodative spasm. Accurate diagnosis requires cycloplegic refraction, yet the condition remains underrecognized in neuro-rehabilitation settings. Aims: To describe a chronic case of PTPM following severe TBI and to evaluate the outcomes of structured vision therapy combined with modified optical correction. Settings and Design: Case report conducted at the Optometry Department, King Saud University Clinical Setting. Materials and Methods: A 27-year-old male with a 5-year history of severe TBI presented with persistent blurred vision, eyestrain, and headaches. Clinical examination revealed a large discrepancy (>7 diopters) between manifest and cycloplegic refraction, confirming accommodative spasm. The patient underwent an 8-week structured vision therapy program with modified lens correction. Functional outcomes, including visual acuity, accommodative amplitude, near point of convergence, stereopsis, and brain injury vision symptom survey (BIVSS) score, were assessed pre-and posttherapy. Results: Posttreatment, the patient demonstrated significant improvements: visual acuity improved to 20/20 −2 , accommodative amplitude increased from 5D to 8D, near point of convergence improved from 12 cm to 6 cm, stereopsis normalized, and suppression resolved. The BIVSS score decreased from >32 to <15, reflecting a substantial reduction in symptoms. Long-term stability was confirmed at a 6-month follow-up. Conclusions: This case highlights the importance of cycloplegic refraction in differentiating pseudomyopia from true myopia and demonstrates the effectiveness of structured vision therapy in restoring binocular and accommodative function, even in chronic posttraumatic cases.