Transnasal endoscopic orbital inner wall decompression combined with penetrating keratoplasty for corneal ulcer perforation in Graves' ophthalmopathy: A case report.

RATIONALE

To report a unique case of corneal ulcer perforation associated with a severe manifestation of Graves' ophthalmopathy that was treated with unilateral transnasal endoscopic orbital inner wall decompression combined with penetrating keratoplasty.

PATIENT CONCERNS

A 66-year-old male with Graves' disease experiencing unilateral corneal ulcer perforation, a rarity in medical literature. He presented with a 9-month history of bilateral exophthalmos accompanied by decreased vision, and over the past month, he experienced loss of vision and painful swelling in the right eye (RE).

DIAGNOSES

After a series of examinations, he was diagnosed with Graves' ophthalmopathy.

INTERVENTIONS

Through local anti-infective treatment, the RE corneal ulcer showed no signs of infection. Once the patient's thyroid function and heart rate were stable and his overall condition was stable, he underwent RE unilateral transnasal endoscopic orbital inner wall decompression combined with penetrating keratoplasty under general anesthesia.

OUTCOMES

The patient underwent successful unilateral transnasal endoscopic orbital inner wall decompression combined with penetrating keratoplasty, resulting in a significant 4 mm reduction in orbital proptosis and it improved the vision and saved the eyes.

LESSONS

Transnasal endoscopic orbital inner wall decompression combined with penetrating keratoplasty is an effective method for treating corneal ulcer perforation caused by Graves' ophthalmopathy. This method can not only greatly improve the appearance but also save the patient's eyeball and improve visual function.