Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2025 Mar 27;17(3):e81293.
doi: 10.7759/cureus.81293. eCollection 2025 Mar.

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

Abha Gour  1 , Aastha Garg  1 , Kajal Singh  1 , Nikunj V Patel  1 , Virender S Sangwan  2
Affiliations
Case Reports

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

Abha Gour et al. Cureus. .

Abstract

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.

Keywords: chronic inflammation; corneal perforation; limbal stem cell deficiency (lscd); ocular surface disorders; visual rehabilitation.

PubMed Disclaimer

Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Inferior corneal melt with a pinpoint leak and iris prolapse
Figure 2
Figure 2. Steps of cyanoacrylate tissue adhesive (CTA) with bandage contact lens (BCL)
(A-C): Debridement of loose epithelium with forceps and cauterization if needed; (D-E): application of CTA with the back of merocele sponge on the de-epithelized cornea; (F): BCL placed
Figure 3
Figure 3. Steps of drape tissue adhesive with bandage contact lens (BCL)
(A): stromal bed prepared; (B, C): 3*3 mm sterile drape applied with tissue adhesive; (D) BCL placed
Figure 4
Figure 4. One-month post-drape tissue adhesive with bandage contact lens (BCL), inferior corneal melt with intraocular lens (IOL) extrusion noted
Figure 5
Figure 5. (A): Central 3 mm perforation with surrounding 7 mm thinning; (B): One month post Tenon's patch graft
Figure 6
Figure 6. Surgical steps of surface mucous membrane grafting
(A): Symblepharon release done, pannus over the central cornea was left in situ; (B) Harvested oral mucosa from the lower lip; (C) multiple partial-thickness vertical incisions made to increase the surface area of the mucosal graft; (D-F): Graft secured to the host tenons with 7-0 vicryl sutures at the four recti and conjunctiva to ensure proper vascular supply of the graft
Figure 7
Figure 7. Three months post surface mucous membrane grafting.; ocular surface stable
Figure 8
Figure 8. Surgical steps of the scleral patch graft
(A): 4*3mm paracentral perforation at the graft host junction; (B-D): measurement and preparation of the scleral rim of the required size; (E, F): Rim sutured to the host sclera and cornea with 10-0 nylon sutures; (G, H): Amniotic membrane placed over the entire ocular surface with fibrin glue
Figure 9
Figure 9. Surgical steps of a conjunctival flap
(A) Pericylindrical melt in keratoprosthesis; (B, C) Conjunctival peritomy done nasally and temporally; (D-F): Conjunctiva mobilized 360 degrees; (G, H): Superior and inferior forniceal conjunctiva separated from the tenon capsule; (I-L): Conjunctiva sutured over the keratoprosthesis with 6-0 vicryl sutures
Figure 10
Figure 10. Two years post conjunctival flap for pericylindrical melt; stable ocular surface
See this image and copyright information in PMC

References

    1. Ocular surface inflammatory disorders (OSID): a collective of systemic etiologies which cause or amplify dry eye syndrome. Soifer M, Azar NS, Mousa HM, Perez VL. Front Med (Lausanne) 2022;9:949202. - PMC - PubMed
    1. Non-traumatic corneal perforations: aetiology, treatment and outcomes. Loya-Garcia D, Serna-Ojeda JC, Pedro-Aguilar L, Jimenez-Corona A, Olivo-Payne A, Graue-Hernandez EO. Br J Ophthalmol. 2017;101:634–639. - PubMed
    1. Differences in surgical management of corneal perforations, measured over six years. Krysik K, Dobrowolski D, Lyssek-Boron A, Jankowska-Szmul J, Wylegala EA. J Ophthalmol. 2017;2017:1582532. - PMC - PubMed
    1. Management of corneal perforation. Jhanji V, Young AL, Mehta JS, Sharma N, Agarwal T, Vajpayee RB. Surv Ophthalmol. 2011;56:522–538. - PubMed
    1. Important concepts for treating ocular surface and tear disorders. Tseng SC, Tsubota K. Am J Ophthalmol. 1997;124:825–835. - PubMed

Publication types

LinkOut - more resources