Corneal graft dehiscence during swinging eyelid orbital decompression

A 68-year-old man with Graves orbitopathy underwent a bilateral swinging eyelid orbital decompression for disfiguring proptosis. A penetrating keratoplasty for keratoconus of the left eye had been performed 13 years earlier. Prior to orbital decompression, biomicroscopy of the left eye showed a partially decompensated sutureless corneal graft with good wound apposition. The corneal stroma appeared edematous, and some epithelial bullae were seen. During orbital wall removal, the corneal wound dehisced for 270 degrees. Swinging eyelid orbital decompression is the technique of choice in the Netherlands for proptosis reduction in Graves orbitopathy. However, spatula pressure on the eye during surgery may cause rupture of the graft-host interface in eyes with previous corneal surgery such as penetrating keratoplasty.