A Case-Based Approach to the Management of Corneal Melts and Perforations in Ocular Surface Disorders

Corneal perforations caused by chronic ocular surface disorders present significant management challenges and can lead to blindness if untreated. This case series reviews the pathophysiology of corneal melts and examines treatment strategies tailored to the size, location, and etiology of perforations in conditions such as Stevens-Johnson syndrome, graft-versus-host disease, and chemical injuries. Through detailed case analyses, various interventions, including cyanoacrylate glue, Tenon's patch grafting, mucous membrane grafts, scleral patch grafts, and conjunctival flaps, were evaluated, along with emerging therapies like biosynthetic hydrogels and collagen-like peptides. Findings highlight the role of chronic inflammation and adnexal abnormalities in disrupting ocular surface integrity, affecting treatment outcomes. This case series underscores the importance of a comprehensive approach that not only repairs corneal defects but also addresses underlying systemic and ocular conditions, with advancements in biosynthetic materials showing promise for improving patient outcomes.