Bilateral Corneal Perforation As A Manifestation Of Severe Vitamin B12 Deficiency In An Adolescent With Extreme Dietary Restriction

To report a rare case of bilateral corneal perforation associated with severe vitamin B12 deficiency in a 15-year-old adolescent with autism spectrum disorder and long-standing extreme selective eating behavior.

Single-center multidisciplinary evaluation at Hospital Alemán, Buenos Aires, Argentina, involving cornea, neuro-ophthalmology, pediatrics, and nutrition specialists.

Case report of a 15-year-old male presenting with bilateral corneal perforation secondary to corneal abscess. The patient had a history of severe dietary restriction limited to processed chicken products since early childhood. Urgent bilateral penetrating keratoplasty was performed. A multidisciplinary evaluation included neuro-ophthalmologic assessment, brain magnetic resonance imaging, electrophysiology, and laboratory testing.

Although anatomical integrity was restored after surgery, visual acuity did not improve beyond light perception. Fundus examination revealed bilateral optic disc pallor. Brain imaging was unremarkable. Electrophysiologic studies showed reduced amplitudes and prolonged latencies. Laboratory testing confirmed severe vitamin B12 deficiency (38 pg/mL; normal range 160–950 pg/mL), consistent with nutritional optic neuropathy. Despite supplementation, optic nerve damage was irreversible.

Although surgical intervention restored ocular integrity, delayed diagnosis of vitamin B12 deficiency resulted in irreversible optic nerve damage. Early systemic evaluation is essential in similar presentations.