• Pei Wang, Zijian Han, Xiuhong Li, Ru Lin, and Hongfeng Yuan.
• Department of Orbital Surgery, Chongqing Aier Eye Hospital, Chongqing, China.
• Medicine (Baltimore). 2024 Oct 4; 103 (40): e39653e39653.

RationaleTo 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 ConcernsA 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).DiagnosesAfter a series of examinations, he was diagnosed with Graves' ophthalmopathy.InterventionsThrough 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.OutcomesThe 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.LessonsTransnasal 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.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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