Peripheral ulcerative keratitis: A review of aetiology and management

Background: Peripheral ulcerative keratitis (PUK) is a severe inflammatory disease of the peripheral cornea that can be caused by local factors or systemic inflammatory disease.Aim: The purpose of this review is to give an overview of the pathophysiology, aetiology, clinical features, diagnosis, and management of PUK.Method: A PubMed search was conducted using the keywords, ‘peripheral ulcerative keratitis’ and ‘Mooren’s ulcer’.Results: The peripheral cornea has unique characteristics the predispose to the development of PUK. These include fine capillary arcades that allow for deposition of immune complexes and subsequent activation of an inflammatory cascade with corneal melt. Several conditions have been implicated in the aetiology of PUK. The most commonly cited causes are rheumatoid arthritis (RA), granulomatosis with polyangiitis (GPA) and various dermatoses. In patients with RA, PUK usually presents in established disease, whereas in GPA, PUK may be the presenting feature in up to 60% of cases. In RA it heralds the onset of a systemic vasculitis with significant associated morbidity and mortality. The management of PUK follows an individualised stepwise approach. All patients require supportive measures to encourage healing and halt the process of keratolysis. Systemic autoimmune conditions need a systemic corticosteroid as a fast-acting agent to halt the inflammatory process while cytotoxic therapy maintains long term disease control. Failure to achieve disease control with CTT, necessitates the use of a biologic agent.Conclusion: Peripheral ulcerative keratitis is a severe inflammatory disease of the peripheral cornea that needs a thorough diagnostic workup and stepwise management approach.

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Peripheral Ulcerative Keratitis with Pyoderma Gangrenosum

Case Reports in Dermatological Medicine ◽

10.1155/2015/949840 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Adrián Imbernón-Moya ◽

Elena Vargas-Laguna ◽

Antonio Aguilar ◽

Miguel Ángel Gallego ◽

Claudia Vergara ◽

...

Keyword(s):

Differential Diagnosis ◽

Pyoderma Gangrenosum ◽

Early Recognition ◽

Skin Lesions ◽

Unusual Event ◽

Peripheral Ulcerative Keratitis ◽

Appropriate Treatment ◽

Autoimmune Conditions ◽

Ulcerative Keratitis ◽

Peripheral Cornea

Pyoderma gangrenosum is an unusual necrotizing noninfective and ulcerative skin disease whose cause is unknown. Ophthalmic involvement in pyoderma gangrenosum is an unusual event. Only a few cases have been reported, from which we can highlight scleral, corneal, and orbital cases. Peripheral ulcerative keratitis is a process which destroys the peripheral cornea. Its cause is still unknown although it is often associated with autoimmune conditions. Pyoderma gangrenosum should be included in the differential diagnosis of peripheral ulcerative keratitis. Early recognition of these manifestations can vary the prognosis by applying the appropriate treatment. We introduce a 70-year-old woman who suffered pyoderma gangrenosum associated with peripheral ulcerative keratitis in her left eye. The patient’s skin lesions and peripheral keratitis responded successfully to systemic steroids and cyclosporine A.

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Anterior Segment Optical Coherence Tomography Imaging in Peripheral Ulcerative Keratitis, a Corneal Structural Description

10.21203/rs.2.22130/v2 ◽

2020 ◽

Author(s):

Clemence BONNET ◽

Louis Debillon ◽

Saba Al-Hashimi ◽

Florence Hoogewoud ◽

Dominique Monnet ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Systemic Vasculitis ◽

Corneal Thickness ◽

Anterior Segment ◽

Case Series ◽

Structural Description ◽

Optical Coherence ◽

Peripheral Ulcerative Keratitis ◽

The Mean ◽

Ulcerative Keratitis

Abstract Background Anterior-segment optical coherence tomography (AS OCT) is an important tool, helpful to diagnose and manage many corneal conditions, but has not been reported in cases of peripheral ulcerative keratitis (PUK). The aim of this study is to describe AS OCT findings in cases of PUK. Methods Retrospective observational case series of six eyes with a PUK with proven systemic vasculitis. Clinical course, slit lamp photographs, and AS OCT findings were the main outcomes. Results The AS OCT findings were found to correlate with the ocular disease’s level of activity. In the acute stage, an absence of corneal epithelium, a scrambled appearance of the anterior stroma and a heterogeneous stromal reflectivity were observed. During the reduction of disease level activity, an irregular hyporeflective epithelium, a smoother anterior stroma, and a homogenous hyperreflective stroma were seen. At the healed stage, a filling of the corneal defect by a hyporeflective thick epithelium, the persistence of the hyperreflective underlying stroma, and a demarcation line were observed. The mean total corneal thickness at last follow-up was significantly thicker (509 ± 147 µm) compared with the mean corneal thickness at onset (408 ± 131 µm; P = 0.03). Conclusions AS OCT provides an assessment of structural changes occurring in PUK, useful for its diagnosis and monitoring.

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Spectral-Domain Optical Coherence Tomography Imaging in Peripheral Ulcerative Keratitis. A Corneal Structural Description

10.21203/rs.2.22130/v1 ◽

2020 ◽

Author(s):

Clemence BONNET ◽

Louis Debillon ◽

Saba Al-Hashimi ◽

Florence Hoogewoud ◽

Dominique Monnet ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Structural Changes ◽

Systemic Vasculitis ◽

Anterior Segment ◽

Case Series ◽

Acute Stage ◽

Structural Description ◽

Optical Coherence ◽

Peripheral Ulcerative Keratitis ◽

Ulcerative Keratitis

Abstract Background: Anterior-segment optical coherence tomography (AS-OCT) is an important tool, helpful to diagnose and manage many corneal conditions, but has not been reported in cases of peripheral ulcerative keratitis (PUK). The aim of this study is to describe AS-OCT findingsin cases of PUK.Methods: Retrospective observational case series of six eyes with a PUK with proven systemic vasculitis. Clinical course, slit-lamp photographs, and AS-OCT findings were the main outcomes.Results: The AS-OCT findings were found to correlate with the ocular disease’s level of activity. In the acute stage, an absence of corneal epithelium, a scrambled appearance of the anterior stroma and a heterogeneous stromal reflectivity were observed. During the reduction of disease level activity, an irregular hyporeflective epithelium, a smoother anterior stroma, and a homogenous hyperreflective stroma were seen. At the healed stage, a filling of the corneal defect by a hyporeflective thick epithelium, the persistence of the hyperreflective underlying stroma, and a demarcation line were observed.Conclusions: AS-OCT provides an assessment of structural changes occurring in PUK, useful for its diagnosis and monitoring.

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Peripheral Ulcerative Keratitis Associated with HCV-Related Cryoglobulinemia

Case Reports in Ophthalmological Medicine ◽

10.1155/2017/9461937 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Pedro Coelho ◽

Carlos Menezes ◽

Rita Gonçalves ◽

Pedro Rodrigues ◽

Elena Seara

Keyword(s):

Hepatitis C ◽

Systemic Vasculitis ◽

Oral Prednisolone ◽

Adjacent Area ◽

Hepatitis C Infection ◽

Medical Background ◽

Peripheral Ulcerative Keratitis ◽

History Of ◽

Illicit Drug Abuse ◽

Ulcerative Keratitis

Purpose. To describe a case of peripheral ulcerative keratitis associated with type II cryoglobulinemia in the context of Hepatitis C infection. Methods. Case report and literature review. Results. A 36-year-old male patient presented to our emergency department with unilateral moderate pain in his right eye, associated with redness and photophobia. Medical background elicited a history of Hepatitis C and IV illicit drug abuse. Ocular examination revealed a BCVA of 20/30 of the affected eye and slight discomfort with eye movement. Biomicroscopy revealed a ring shaped peripheral corneal ulcer, with a dense white stromal infiltrate sparing the limbus, plus an adjacent area of mild anterior diffuse nonnecrotizing scleritis. No intraocular inflammation was present. Posterior segment was normal. The patient was placed under oral prednisolone (1 mg/Kg/day) with gradual tapering. A dramatic clinical response occurred, with complete resolution of the clinical condition. Systemic analytic workup aiming at autoimmune and infectious diseases was negative, except for high HCV-viral load and the presence of type 2 cryoglobulins. Conclusion. Albeit rare, cryoglobulinemia, even in the absence of systemic vasculitis, should be considered in the differential diagnosis of PUK, when systemic workout for autoimmune diseases is negative.

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