Corneal breakdown in thyroid eye disease: Presentation and outcomes over a decade

Area of Science:

• Ophthalmology
• Endocrinology
• Corneal Surgery

Background:

• Corneal breakdown is a sight-threatening emergency in Thyroid Eye Disease (TED).
• Prompt and comprehensive management is essential for preserving vision and ocular integrity.

Purpose of the Study:

• To evaluate the outcomes of multimodal management strategies for corneal breakdown in patients with TED.
• To assess the impact of interventions on visual acuity, proptosis, and globe salvage rates.

Main Methods:

• Retrospective audit of consecutive TED patients with corneal breakdown (November 2011 - May 2023).
• Primary outcome: Best Corrected Visual Acuity (BCVA). Secondary outcomes: Proptosis, Clinical Activity Score (CAS), globe salvage.
• Analysis of outcomes following orbital decompression and medical management.

Main Results:

• 35 TED patients (50 eyes) were analyzed, with corneal breakdown varying from superficial keratopathy to microbial keratitis with perforation.
• Orbital decompression significantly improved BCVA (1.2 to 0.7) and reduced proptosis (25.4 to 20.7 mm).
• Overall, 88% of eyes achieved globe salvage; severe cases with perforation showed substantial vision and globe salvage with multimodal care.

Conclusions:

• Expeditious and intensive multimodal management is vital for corneal breakdown in TED.
• This includes topical/systemic medications, eyelid surgery, and orbital decompression.
• Multimodal therapy yields high rates of vision and globe salvage, particularly in severe corneal complications.