# Krukenberg’s Spindle-Like Corneal Changes in a Patient With Prolonged ICU Admission: A Case Report

## TL;DR

A 39-year-old man developed Krukenberg’s spindle-like corneal changes after a long ICU stay due to thyroid storm and infective endocarditis.

## Contribution

This case report describes a rare variant of Krukenberg’s spindles linked to prolonged ICU care, not typical pigment dispersion syndrome.

## Key findings

- The patient showed bilateral brownish linear corneal changes resembling Krukenberg’s spindles.
- Classic causes like PDS and drug-induced keratopathy were ruled out.
- ICU-related factors may have contributed to the atypical pigment dispersion.

## Abstract

Krukenberg's spindles are vertical, spindle-shaped pigment deposits on the posterior cornea and are primarily associated with pigment dispersion syndrome (PDS). We present a case of Krukenberg's spindle-like corneal changes in a 39-year-old male patient following prolonged ICU management for thyroid storm complicated by infective endocarditis. The patient's complex ICU course included mechanical ventilation, veno-arterial extracorporeal membrane oxygenation (VA-ECMO), and multiple medications. Ophthalmological examination revealed bilateral, brownish, linear changes in the central corneal stroma and a normal endothelial cell count. Various conditions, including drug-induced keratopathy and systemic diseases, were excluded. The findings presented a distinctive pattern of Krukenberg's spindle-like corneal changes following a prolonged ICU stay. While morphologically resembling classic Krukenberg's spindle, the condition had clinical features differing from those of typical PDS. Although the exact mechanism remains unclear, multiple factors in the ICU environment, such as the effects of medication on pupillary dynamics, thyroid storm-associated autonomic changes, patient positioning, and systemic conditions, may have contributed to causing this variant of pigment dispersion. This report emphasizes the need for ophthalmological evaluation following an extended ICU stay.