Peripheral Ulcerative Keratitis

Abstract

Peripheral ulcerative keratitis (PUK) affects the juxtalimbal cornea and classically presents with epithelial defect and stromal lysis. This inflammatory condition results in a complex interplay between host autoimmunity, the anatomy and physiology of the peripheral cornea, and the environment. The underlying cause could be local or systemic, infectious or noninfectious. PUK can be due to vasculitides and collagen vascular disease; rheumatoid arthritis (RA), granulomatosis with polyangiitis (GPA), and systemic lupus erythematosus (SLE) can account for up to 53% of PUK cases. PUK in scleritis is a poor prognostic factor. Progressive stromal lysis can cause corneal perforation, and in patients with an underlying autoimmune disease indicates significant morbidity and mortality.PUK without systemic association is known as Mooren's ulcer (MU) and contributes to 31.5% of PUK causes. Bowman first described it in 1849, followed by McKenzie in 1854, as an ulcus roden of the cornea. Mooren's ulcer occurs in the absence of scleritis and is a diagnosis of exclusion. Clinical signs begin in the peripheral cornea and progress centrally and circumferentially, with a distinctive overhanging edge. PUK is important to diagnose as it can be the first presenting feature of a life-threatening systemic disease. Meticulous clinical investigation and multi-disciplinary management are required to ensure safe patient outcomes.