{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T20:51:09Z","timestamp":1793307069360,"version":"4.5.0"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T00:00:00Z","timestamp":1743033600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>Corneal breakdown in thyroid eye disease (TED) is an ocular emergency. This study aimed to assess the outcome of multimodal management for corneal breakdown in TED.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This retrospective audit included all consecutive corneal breakdowns in TED patients between November 2011 and May 2023. The primary outcome measure was the best corrected visual acuity (BCVA), and secondary outcome measures included proptosis, clinical activity score (CAS), and proportion of globe salvage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>In all, 35 TED patients (50 eyes; 15 bilateral) were included in this study. The mean age was 50.6 + 16 years (range 17\u201383), and 23 were male. Median TED duration was 5 months (range 1\u2013108). Seven patients (nine eyes) developed corneal breakdown \u22652 years after disease onset. Corneal breakdown was graded as superficial punctate keratopathy in 18, microbial keratitis in 14, and microbial keratitis with thinning and\/or perforation in 18 eyes. At median follow-up of 17 months (range 2\u201372), in the orbital decompression group, overall mean BCVA before and after orbital decompression showed improvement from 1.2 to 0.7, mean proptosis from 25.4 \u00b1 3.5 to 20.7 \u00b1 2.1 mm, and median CAS from 4.2 \u00b1 1.3 to 0.3 \u00b1 0.6. In the medical management group, the mean BCVA changed from 1.7 to 1.5, mean proptosis from 22.5 \u00b1 2.5 to 22.3 \u00b1 2.4 mm, and CAS from 3.0 \u00b1 1.4 to 1.1 \u00b1 1.4 before and after treatment, respectively. At the final follow-up, 44 eyes (88%) achieved globe salvage, while six eyes were eviscerated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Corneal breakdown necessitates expeditious and intensive multimodal management \u2013 topical medications, systemic medications, eyelid surgery, and orbital decompression surgery. In severe corneal breakdown with microbial keratitis with thinning and perforation, multimodal management helps achieve a high percentage of vision and globe salvage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijo.ijo_1067_24","type":"journal-article","created":{"date-parts":[[2025,3,30]],"date-time":"2025-03-30T08:56:09Z","timestamp":1743324969000},"page":"567-576","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Corneal breakdown in thyroid eye disease: Presentation and outcomes over a decade"],"prefix":"10.4103","volume":"73","author":[{"given":"Prasansha","family":"Narnoli","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery Service, L.V. Prasad Eye Institute, Bhubaneswar, Odisha, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suryasnata","family":"Rath","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery Service, L.V. Prasad Eye Institute, Bhubaneswar, Odisha, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devjyoti","family":"Tripathy","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery Service, L.V. Prasad Eye Institute, Bhubaneswar, Odisha, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samir","family":"Mohapatra","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery Service, L.V. Prasad Eye Institute, Bhubaneswar, Odisha, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Smruti R","family":"Priyadarshini","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Cornea and Anterior Segment Services, L.V. Prasad Eye Institute, Bhubaneswar, Odisha, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sujata","family":"Das","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Cornea and Anterior Segment Services, L.V. Prasad Eye Institute, Bhubaneswar, Odisha, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md Hasnat","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Biostatistics, L. V. Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,3,27]]},"reference":[{"key":"R1-20260422","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1111\/cen.13880","article-title":"Sight-threatening graves\u2019orbitopathy: Twenty Years experience of a multidisciplinary thyroid-eye outpatient clinic","volume":"90","author":"Tramunt","year":"2018","journal-title":"Clin Endocrinol"},{"key":"R2-20260422","doi-asserted-by":"crossref","first-page":"87","DOI":"10.3109\/01676830.2013.764440","article-title":"Ocular surface changes in thyroid eye disease","volume":"32","author":"Ismailova","year":"2013","journal-title":"Orbit"},{"key":"R3-20260422","first-page":"57","article-title":"The relationship between Graves\u2019 ophthalmopathy and dry eye syndrome","volume":"9","author":"Selter","year":"2014","journal-title":"Clin Ophthalmol"},{"key":"R4-20260422","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.ajo.2018.10.001","article-title":"Comorbidities and prescribed medications in patients with or without dry eye disease: A population-based study","volume":"98","author":"Dana","year":"2019","journal-title":"Am J Ophthalmol"},{"key":"R5-20260422","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1111\/aos.14000","article-title":"Dry eye syndrome in thyroid eye disease patients: The role of increased incomplete blinking and meibomian gland loss","volume":"97","author":"Park","year":"2019","journal-title":"Acta Ophthalmol"},{"key":"R6-20260422","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1111\/j.1395-3907.2004.00268.x","article-title":"Dry eye syndrome in thyroid-associated ophthalmopathy: Lacrimal expression of TSH receptor suggests involvement of TSHR-specifc autoantibodies","volume":"82","author":"Eckstein","year":"2004","journal-title":"Acta Ophthalmol"},{"key":"R7-20260422","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1016\/j.ajo.2013.12.027","article-title":"Topical rebamipide treatment for superior limbic keratoconjunctivitis in patients with thyroid eye disease","volume":"157","author":"Takahashi","year":"2014","journal-title":"Am J Ophthalmol"},{"key":"R8-20260422","doi-asserted-by":"crossref","first-page":"G43","DOI":"10.1530\/EJE-21-0479","article-title":"The 2021 European Group On Graves\u2019 Orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves\u2019 orbitopathy","volume":"185","author":"Bartalena","year":"2021","journal-title":"Eur J Endocrinol"},{"key":"R9-20260422","doi-asserted-by":"crossref","first-page":"1446","DOI":"10.4103\/ijo.IJO_365_22","article-title":"Magnetic resonance imaging in thyroid eye disease: Signal intensity ratio to measure disease activity","volume":"70","author":"Rath","year":"2022","journal-title":"Indian J Ophthalmol"},{"key":"R10-20260422","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1097\/IOP.0000000000001871","article-title":"Sight-threatening thyroid eye disease: Role of diabetes mellitus and interaction with other risk factors","volume":"37","author":"Rath","year":"2021","journal-title":"Ophthalmic Plast Reconstr Surg"},{"key":"R11-20260422","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/0002-9394(69)91246-X","article-title":"Classification of the eye changes in Graves disease","volume":"68","author":"Werner","year":"1969","journal-title":"Am J Ophthalmol"},{"key":"R12-20260422","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1097\/01.iop.0000235499.34867.85","article-title":"VISA Classification for graves ophthalmopathy","volume":"22","author":"Dolman","year":"2006","journal-title":"Ophthal Plast Reconstr Surg"},{"key":"R13-20260422","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1136\/bjo.73.8.639","article-title":"Clinical criteria for the assessment of disease activity in Graves\u2019 ophthalmopathy: A novel approach","volume":"73","author":"Mourits","year":"1989","journal-title":"Br J Ophthalmol"},{"issue":"6S","key":"R14-20260422","doi-asserted-by":"crossref","first-page":"S81","DOI":"10.1097\/IOP.0000000000002511","article-title":"Magnetic resonance imaging in the management of thyroid eye disease: A systematic review","volume":"39","author":"Vaishnav","year":"2023","journal-title":"Ophthalmic Plast Reconstr Surg"},{"key":"R15-20260422","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1097\/IOP.0000000000001361","article-title":"Microbial keratitis in thyroid eye disease: Clinical features, microbiological profile, and treatment outcome","volume":"35","author":"Naik","year":"2019","journal-title":"Ophthal Plast Reconstr Surg"},{"key":"R16-20260422","doi-asserted-by":"crossref","first-page":"26.","DOI":"10.4103\/2230-8210.109707","article-title":"Endoscopic orbital decompression for Graves\u2032 orbitopathy","volume":"17","author":"Thakar","year":"2013","journal-title":"Indian J Endocrinol Metab"}],"container-title":["Indian Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/IJO.IJO_1067_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:58:10Z","timestamp":1786647490000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/IJO.IJO_1067_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,27]]},"references-count":16,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/ijo.ijo_1067_24","relation":{},"ISSN":["0301-4738","1998-3689"],"issn-type":[{"value":"0301-4738","type":"print"},{"value":"1998-3689","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,27]]},"assertion":[{"value":"2024-05-07","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-30","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}