Peripheral Ulcerative Keratitis: A Review

Abstract

Peripheral ulcerative keratitis (PUK) is a rare but serious ocular condition that is an important clinical entity due to its ophthalmological and systemic implications. It is characterized by progressive peripheral corneal stromal thinning with an associated epithelial defect and can be associated with an underlying local or systemic pro-inflammatory condition, or present in an idiopathic form (Mooren ulcer). Associated conditions include autoimmune diseases, systemic and ocular infections, dermatologic diseases, and ocular surgery. Cell-mediated and autoantibody- mediated immune responses have been implicated in the pathogenesis of PUK, destroying peripheral corneal tissue via matrix metalloproteinases. Clinically, patients with PUK present with painful vision loss, a peripheral corneal ulcer, and often adjacent scleritis, episcleritis, iritis, or conjunctivitis. Diagnostic evaluation should be focused on identifying the underlying etiology and ruling out conditions that may mimic PUK, including marginal keratitis and Terrien marginal degeneration. Treatment should be focused on reducing local disease burden with topical lubrication, while simultaneously addressing the underlying cause with antimicrobials or anti-inflammatory when appropriate. Existing and emerging biologic immunomodulatory therapies have proven useful in PUK due to autoimmune conditions. Surgical treatment is generally reserved for cases of severe thinning or corneal perforation.

The Atypical Red Eye: A Case of Scleritis with Peripheral Ulcerative Keratitis Secondary to Granulomatosis with Polyangiitis

“…Messmer and Foster [4] describe that the presence of PUK and scleritis are poor prognostic indicators for systemic GPA severity. Preventing corneal perforation has been shown to have significant long-term impact on both visual and systemic health outcomes [5] . Fu and Jones [6] demonstrated 65% of their patient cohort with corneal perforations had final visual outcomes of hand movements or less, and a 1-year mortality of 24%.…”

“…Fu and Jones [6] demonstrated 65% of their patient cohort with corneal perforations had final visual outcomes of hand movements or less, and a 1-year mortality of 24%. Medical management with systemic immunosuppression remains the mainstay of treatment with adjuvant surgical techniques aimed at maintaining corneal stromal integrity [5] . Cyanoacrylate glue with juxtalimbal conjunctival resection was employed in this case before corneal perforation could occur.…”

Bacterial Keratitis. Part 2. Topical Aspects of Treatment

“…В обоих случаях наблюдалась стабилизация кератомаляции [13]. Пероральный прием доксициклина и витамина С в настоящее время рассматривается, как возможное дополнительное средство в тяжелых случаях при риске кератолиза [14].…”

Inflammatory eye disease for rheumatologists

“…PUK can be a complication of scleritis, and should be treated aggressively with IMT, which has been shown to improve morbidity in this group [56]. As in scleritis, anti-CCP antibodies are associated with more severe disease [55]. The mainstay of immunosuppressive treatment is similar to scleritis, and close collaboration with an ocular immunologist and a cornea specialist is essential.…”