Ulcer, Corneal Workup

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

Laboratory Studies

  • Polymyositis and dermatomyositis - Elevated serum muscle enzyme levels, especially creatine phosphokinase (CK), serum glutamic-oxaloacetic transaminase (SGOT), serum glutamic-pyruvic transaminase (SGPT), and lactate dehydrogenase (LDH), as well as elevated ANA levels
  • Wegener granulomatosis - Abnormal chest x-ray; urinary sediment-microhematuria or red blood cell casts; positive antineutrophil cytoplasmic antibody (C-ANCA) appears to be the most sensitive and specific test outside of biopsy for the diagnosis this condition.
  • Polyarteritis nodosa - Elevated blood urea nitrogen or creatinine level; presence of hepatitis B surface antigen or antibody in serum; arteriographic evidence of aneurysms or occlusions (nonarteriosclerotic); presence of polymorphonuclear cells in artery walls on biopsy of small- or medium-sized arteries
  • Mooren ulcer - A deficiency of suppressor T cells has been found in the serum of a patient with Mooren ulcer, while another study showed a helper T cell/suppressor cell ratio of greater than 1:1 in 6 of 9 patients with Mooren ulcer. Recent studies have shown that most of the resident cells from specimens with Mooren ulcers express the class 2 antigens, human leukocyte antigen DR (HLA-DR) or human leukocyte antigen DQ (HLA-DQ). Another study demonstrated that the sera from patients with Mooren ulcer had high antibody titers to a cornea-specific stromal protein antigen.
  • Systemic lupus erythematosus - Of patients with SLE, 50-60% have antibodies to cardiolipin. The American College of Rheumatology has suggested 11 classification criteria for SLE. Patients are considered to have SLE if they meet 4 of the following criteria:
    • Malar rash
    • Discoid rash
    • Photosensitive rash
    • Oral ulcers
    • Nonerosive arthritis in 2 or more joints
    • Pleuritis or pericarditis
    • Glomerulonephritis or proteinuria
    • Seizures or psychosis
    • Hemolytic anemia, leukopenia, lymphopenia, or thrombocytopenia
    • Immunologic laboratory abnormality, such as antibodies to double-stranded DNA or the SM antigen or a false-positive serologic test for syphilis
    • Positive ANA test that is not caused by a medication
  • Wegener granulomatosis - C-ANCA
  • Scleroderma - Anti-Sci-70 antibody tests and anticentromere antibodies (CREST variant)
  • Rheumatoid arthritis - Approximately 80% of patients with RA have a positive test for rheumatoid factor.
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Histologic Findings

In Wegener granulomatosis, histologic findings include necrotizing, granulomatous vasculitis with infiltrative neutrophils, lymphocytes, plasma cells, histiocytes, and giant cells.

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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

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  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].

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  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].

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  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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