Ulcer, Corneal Clinical Presentation

  • Author: Fernando H Murillo-Lopez, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Jan 28, 2010
 

History

A complete systemic medical history and a review of systems are imperative in these patients, including questions regarding the presence of weight loss, malaise, muscle pain, or weakness, and symptoms involving the neurologic, respiratory, and renal systems.

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Physical

  • Keratitis sicca is quite common with these patients. Superficial punctate keratitis, chemosis, recurrent episcleritis, and scleritis also are common findings.
  • In the case of SLE, retinal vasculitis is evident on fluorescein angiography, with intraretinal hemorrhages and cotton-wool spots. Of patients, 95% develop arthralgia and articular findings, and 70-80% of patients develop skin lesions at some point. The butterfly rash across the nose and cheek occurs in about 30% of patients with SLE.
  • Mooren ulcer begins as a gray-white infiltrate in the peripheral cornea followed by epithelial breakdown and stromal melting. Eventually, it develops into a chronic, painful peripheral corneal ulcer that progresses circumferentially and centrally, creating an overhanging edge at its central border. The adjacent conjunctiva and sclera usually are inflamed and hyperemic.
  • Wegener granulomatosis is characterized by nasal or oral inflammation, necrotizing and granulomatous inflammation of the vessels of the upper and lower respiratory tract, glomerulonephritis, and other organ involvement with small vessel inflammation.
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Causes

All the underlying systemic conditions leading to these types of corneal ulcers are likely to have an autoimmune etiology that is linked to genetic susceptibility.

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Contributor Information and Disclosures
Author

Fernando H Murillo-Lopez, MD  Senior Surgeon, Unidad Privada de Oftalmologia CEMES

Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Specialty Editor Board

Kilbourn Gordon III, MD, FACEP  Urgent Care Physician

Kilbourn Gordon III, MD, FACEP is a member of the following medical societies: American Academy of Ophthalmology and Wilderness Medical Society

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

J James Rowsey, MD  Former Director of Corneal Services, St Luke's Cataract and Laser Institute, Florida

J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Pan-American Association of Ophthalmology, Sigma Xi, and Southern Medical Association

Disclosure: Nothing to disclose.

Ralph Garzia, OD  Assistant Dean for Clinical and Academic Programs, Associate Professor, College of Optometry, University of Missouri at St Louis

Ralph Garzia, OD is a member of the following medical societies: American Academy of Optometry and American Optometric Association

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. Paroli MP, Pinca M, Speranza S, Marino M, Pivetti-Pezzi P. Paracentral corneal melting in a patient with Vogt-Koyanagi-Harada's syndrome, psoriasis, and Hashimoto's thyroiditis. Ocul Immunol Inflamm. Dec 2003;11(4):309-13. [Medline].

  2. Asai T, Nakagami T, Mochizuki M. Three cases of corneal melting after instillation of a new nonsteroidal anti-inflammatory drug. Cornea. Feb 2006;25 (2):224-7. [Medline].

  3. Flach AJ. Corneal melts associated with topically applied nonsteroidal anti-inflammatory drugs. Trans Am Ophthalmol Soc. 2001;99:205-10; discussion 210-2. [Medline].

  4. Guidera AC, Luchs JI, Udell IJ. Keratitis, ulceration, and perforation associated with topical nonsteroidal anti-inflammatory drugs. Ophthalmology. May 2001;108(5):936-44. [Medline].

  5. Lambiase A, Bonini S, Aloe L, et al. Anti-inflammatory and healing properties of nerve growth factor in immune corneal ulcers with stromal melting. Arch Ophthalmol. Oct 2000;118(10):1446-9. [Medline].

  6. Schechter BA, Rand WJ, Nagler RS. Corneal melt after amniotic membrane transplant. Cornea. Jan 2005;24(1):106-7. [Medline].

  7. Wilson SE, Lee WM, Murakami C, Weng J, Moninger GA. Mooren-type hepatitis C virus-associated corneal ulceration. Ophthalmology. Apr 1994;101(4):736-45. [Medline].

  8. Vanathi M, Sharma N, Titiyal JS. Tectonic grafts for corneal thinning and perforations. Cornea. Nov 2002;21(8):792-7. [Medline].

  9. Foster CS, Forstot SL, Wilson LA. Mortality rate in rheumatoid arthritis patients developing necrotizing scleritis or peripheral ulcerative keratitis. Effects of systemic immunosuppression. Ophthalmology. Oct 1984;91(10):1253-63. [Medline].

  10. Bullen CL, Liesegang TJ, McDonald TJ, DeRemee RA. Ocular complications of Wegener's granulomatosis. Ophthalmology. Mar 1983;90(3):279-90. [Medline].

  11. Lambiase A, Rama P, Bonini S, et al. Topical treatment with nerve growth factor for corneal neurotrophic ulcers. N Engl J Med. Apr 23 1998;338(17):1174-80. [Medline].

  12. Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. Sep 1997;40(9):1725. [Medline].

  13. Jayson MI, Jones DE. Scleritis and rheumatoid arthritis. Ann Rheum Dis. Jul 1971;30(4):343-7. [Medline].

  14. Robin JB, Schanzlin DJ, Meisler DM, et al. Ocular involvement in the respiratory vasculitides. Surv Ophthalmol. Sep-Oct 1985;30(2):127-40. [Medline].

  15. West RH, Barnett AJ. Ocular involvement in scleroderma. Br J Ophthalmol. Dec 1979;63(12):845-7. [Medline].

 
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