Peripheral Corneal Ulcer Research Articles

Peripheral corneal ulcers associated with use of African traditional eye medicines.

The most common cause of monocular blindness in Africa is corneal opacification. Traditional eye medicines (TEM) are widely used in Africa and their use has been associated with corneal ulceration, however, no controlled studies of the effects of TEM on the cornea have been published. We conducted a case-control study of 39 patients with corneal ulcers matched to controls with severe conjunctivitis. Microbiological investigations were conducted on 20 cases. There was a significant association between corneal ulceration and TEM use and, in particular, peripheral corneal ulcerations were significantly associated with TEM use.

Peripheral corneal ulceration in rigid gas permeable extende wear: A case report

This report examines factors associated with the development of a peripheral corneal ulcer in a patient wearing rigid gas permeable extended wear lenses. Contributing factors included poor patient selection, lens design, wearing schedule, 3 and 9 o'clock staining, and patient noncompliance. Recommendations are made as to how such a complication can be avoided.

Inflammatory Diseases of the Peripheral Cornea

Immunologic differences exist between the peripheral and central cornea. The peripheral cornea is closer to the conjunctiva, which has all of the immunologic machinery necessary to generate an immune response. The peripheral cornea has more Langerhans' cells and IgM than the central cornea. The peripheral cornea also has more C1, the recognition unit of the classic pathway of complement, than the central cornea so that antigen-antibody complexes, whether formed in the cornea itself or whether derived from the tears, aqueous humor, or limbal vessels, may activate complement more effectively in the peripheral than central cornea. Autoimmune diseases that involve the peripheral cornea include Mooren's ulcer and collagen vascular diseases. The humoral- and cell-mediated autoimmune phenomena that are associated with Mooren's ulcer and its response to immunosuppressive therapy suggest that it is an autoimmune disease directed against the cornea itself. Collagen vascular diseases may be associated with peripheral corneal ulcers with or without scleritis. In these diseases, circulating immune complexes may lodge in the limbal vasculature causing an immune vasculitis or deposit in the peripheral cornea setting off the complement cascade. Peripheral corneal diseases that probably represent a hypersensitivity reaction to exogenous antigens include catarrhal infiltrates and ulcers and phlyctenules. In the United States today, these corneal lesions are generally associated with staphylococcal blepharitis. Experimental models suggest that hypersensitivity to Staphylococcus aureus cell wall antigens may be important to their immunopathogenesis.

Abnormal expression of HLA class II antigens in conjunctival epithelia in peripheral corneal ulcers

Inflammatory mediators originating at the limbus seem to play an important role in the pathogenesis of peripheral corneal ulcers. In this paper, the immunohistological results of conjunctival biopsies of patients with corneal ulcers are reported. The most important result was that an abnormal HLA class II expression was found. The expression of HLA-DR was stronger than that of HLA-DQ and HLA-DP. A model of ulcer formation involving T-cells and lymphokines is presented.

Mooren's Ulcer After Penetrating Keratoplasty

Seventeen months after penetrating keratoplasty for pseudophakic bullous keratopathy, a patient developed severe pain and a peripheral corneal ulcer that had the characteristic clinical appearance of a Mooren's ulcer. We performed a 10-mm penetrating keratoplasty that extended from the superior margin of the previously placed graft to the inferior corneoscleral limbus to encompass the ulcerated cornea. Histopathologic examination of tissue removed at surgery disclosed that the peripheral corneal ulcer extended nearly through the entire stromal thickness and that the donor corneal stroma adjacent to the ulcer was infiltrated with lymphocytes, plasma cells, and neutrophils. The conjunctiva adjacent to the peripheral corneal ulcer was packed with plasma cells and also showed some lymphocytes and neutrophils.

HLA AND EXTERNAL DISEASES OF THE EYE

Among the external diseases of the eye, pemphigus vulgaris, ocular cicatrical pemphigoid, Sjögren's syndrome, herpes simplex keratitis, Cogan's syndrome, scleritis, vernal catarrh, keratoconus, tuberculoid leprosy, Mooren's ulcer, staphylococcal peripheral corneal ulcerations, non‐herpetic keratitis and corneal dystrophy have been studied for the association with HLA antigens. Pemphigus vulgaris is shown to be associated with HLA‐A10 (A26), and HLA‐DR4, ocular cicatrical pemphigoid with HLA‐B12, Sjögren's syndrome with HLA‐Dw3 and HLA‐DR3, and tuberculoid leprosy with HLA‐DR2.

Adverse Reactions to Virgin Silk Sutures in Cataract Surgery

During the past 3 years, 12 patients (14 eyes) were encountered with severe reactions to virgin silk sutures used in cataract surgery. These reactions included nodular episcleritis, peripheral corneal ulceration, and wound necrosis with dehiscence, sometimes resulting in endophthalmitis or epithelial downgrowth. Conjunctival and scleral histopathologic studies in four eyes showed acute and chronic inflammation with multinucleated giant cells. Successful treatment included removal of the virgin silk sutures, resuturing with 10-0 nylon sutures, securing the necrotic tissue with cyanoacrylate adhesive, and resection of the inflamed superior conjunctiva. All four patients who had bilateral cataract surgery experienced either simultaneous flare-ups of both eyes or accelerated reactions after surgery on the second eye, which suggests a possible role of prior sensitization.

Conjunctival Resection for the Treatment of the Rheumatoid Corneal Ulceration

Conjunctival resection is an effective therapeutic modality for the treatment of a marginal furrow associated with rheumatoid arthritis. Rapid reepithelialization was observed following this procedure for the treatment of five such stromal ulcers that occurred in three rheumatoid patients. Keratoconjunctivitis sicca was diagnosed in two of these patients. In four of five ulcers, minimal healing resulted from a prior trial of patching. Conjunctival resection was performed as the primary therapeutic procedure in one case in which perforation seemed possible. A literature review uncovered an additional nine such ulcers in six rheumatoid patients treated by conjunctival resection. In each case corneal healing was observed soon after the procedure. No recurrences were reported on 4- to 24-month follow-ups. This procedure has proven to be effective in each of our rheumatoid corneal ulcers and in each of the case reports in the literature. It would appear to work more reliably than subconjunctival heparin, topical anticollagenases, or immunosuppression. Conjunctival resection is a simple minor room procedure performed under topical anesthesia. It carries minimal risk for the patient. The early use of this technique for rheumatoid stromal ulcers is advocated, especially when the area of ulceration is extensive, when the stromal loss is progressive, and when stromal reserve is minimal. Early conjunctival resection can shorten the hospital stay, and in more severe cases could prevent perforation. Based on successful treatment in a combined total of 14 peripheral rheumatoid corneal ulcerations, the authors believe Conjunctival resection should have a more prominent place in the treatment of this condition.

Presence of circulating immune complexes in patients with peripheral corneal disease.

Seventeen patients with peripheral corneal thinning and ulcers (four with Mooren's corneal ulcer, five with Terrien's marginal degeneration, and eight with collagen vascular disease) were tested for immune complexes in their serum. Circulating immune complexes, measured by Raji cell and C1q binding assays, were compared with levels in serum samples from normal controls and seven patients with staphylococcal marginal corneal ulcers. Comparison with normal controls showed significantly higher levels of circulating immune complexes in patients with collagen disease by the C1q binding assay and in patients with Mooren's ulcer by the Raji cell assay. Circulating immune complexes may play a role in the pathogenesis of Mooren's ulcer and marginal ulceration in the presence of collagen vascular disease. Their presence, however, may represent an epiphenomenon nonspecifically associated with corneal ulceration.

Peripheral Corneal Ulcers, Conjunctival Ulcers, and Scleritis after Cataract Surgery

After undergoing uneventful cataract extractions, four patients developed an inflammatory reaction that included scleritis and peripheral corneal infiltrates and ulcers. Two of these patients also developed conjunctival ulcers. The inflammatory reaction in all four patients responded to topical corticosteroids.

Prolonged wear soft contact lenses

Of 78 patients eligible for prolonged wear contact lenses, 50 (65%) were successfully fitted and followed for four months to four years. The most serious complication was peripheral corneal ulceration, occurring in 5 (10%) patients. None of these patients suffered permanent visual loss. The fitting of prolonged wear lenses required six or seven office visits during the first year and at least one lens per eye during the first year, for uncomplicated cases. In difficult cases the number of office visits and the number of replacement lenses increased significantly. In terms of the number of office visits and replacement lenses, the soft contact lens compares unfavorably with the intraocular lens. It is our feeling that the prolonged wear soft contact lens should be used when a lens implant is contraindicated or as an alternative to secondary lens implantation.

Peripheral Rheumatoid Ulceration and Evidence For Conjunctival Collagenase Production

Two patients with rheumatoid arthritis and peripheral corneal ulcerations were successfully treated by conjunctival resection. The tissues removed were assayed by a variation of the radial diffusion method for tissue collagenases. We used an agarose matrix containing lathyritic rat skin collagen. Wells 3 mm deep were punched in the agarose-collagen and surgical specimens were placed in the wells. Spaces remaining in the wells were filled with balanced salt solution. The assay dishes were incubated for four days at 32 degrees C near 100% humidity. Under these conditions release of collagenase was detected by the clearing of diffuse zones in the gel surrounding the well. Conjunctiva proximal to the ulcer produced definite zones of lysis, whereas control specimens taken remote to the ulceration produced no lysis. This direct evidence for collagenase involvement offers an exploration for the beneficial effects of conjunctival resection.

Marginal Corneal Ulcers with Acute Beta Streptococcal Conjunctivitis and Chronic Dacryocystitis

A 73-year-old woman had right dacryocystitis, intense conjunctival hyperemia and chemosis, marginal corneal ulcers, and abscesses and conjunctival cultures that were positive for beta hemolytic streptococci. A distinct lucid interval separated the peripheral corneal ulcers and infiltrates from the corneoscleral limbus. Gram stain of corneal scrapings revealed polymorphonuclear leukocytes but no bacteria, and corneal cultures were negative for bacteria. The peripheral corneal ulcers and abscesses in our patient with the lacrimal conjunctivitis of Morax clinically resembled the catarrhal ulcers found with staphylococcal blepharitis. A hypersensitivity or toxic reaction to streptococci or their products may have played a role in the development of the marginal ulcers in this patient.

Peripheral Corneal Ulcers with Herpes Zoster Ophthalmicus

Four patients with herpes zoster ophthalmicus developed peripheral corneal ulcers with steep central edges. An anterior uveitis was associated with all cases. One patient developed bilateral corneal ulcers that were typical of Mooren's ulcer and eventually destroyed both corneas. The other three cases were unilateral and were not relentlessly progressive.

Autoimmune Phenomena of the External Eye

The immunologic status of patients with ocular pemphigoid, Mooren's ulcer, chronic herpetic keratitis, and staphylococcal peripheral corneal ulcers was studied. Although tissue-fixed and circulating antibodies to the conjunctival epithelium were found in all groups, patients with Mooren's ulcer demonstrated these findings most consistently. Immunoglobulins bound to the conjunctival basement membrane were found not only in ocular pemphigoid but also in patients with Mooren's and staphylococcal ulcers. Approximately one half of the patients with ocular pemphigoid and Mooren's ulcer demonstrated elevations in serum IgA levels. An increased prevalence of HLA-B12 was found in ocular pemphigoid.

FOREIGN BODY IN THE EYE

<h3>To the Editor.</h3> —Regarding the query on feeling of foreign body in the eye (Arch Ophthal<b>76</b>:902 [Dec] 1966), one more very frequently overlooked possibility in patients of this age and older is senile laxity of the conjunctiva when it is thrown into folds by movement of the eye and pressure by the lids especially at the lower limbus (Hughes, W.L.: Conjunctivochalasis,<i>Amer J Ophthal</i><b>25</b>:48, 1942). Other manifestations of this condition are sudden sharp pains, recurrent subconjunctival hemorrhages, and even peripheral marginal corneal ulceration in severe cases. P. S. I enjoy the new query department very much.