eMedicine Specialties > Emergency Medicine > Ophthalmology

Corneal Ulceration and Ulcerative Keratitis: Differential Diagnoses & Workup

Author: Trevor John Mills, MD, MPH, Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Associate Professor of Emergency Medicine, Louisiana State University Health Sciences Center
Contributor Information and Disclosures

Updated: Sep 15, 2008

Differential Diagnoses

Herpes Zoster
Herpes Zoster Ophthalmicus

Other Problems to Be Considered

Corneal foreign body
Blepharitis
Mooren ulcer
Terrien degeneration
Herpes simplex keratitis

Workup

Laboratory Studies

Perform the following for corneal ulcers:

  • Culture the ulcer.
  • Rheumatoid arthritis evaluation

Other Tests

  • Scrapings of the ulcer may be necessary to identify the underlying organism. Place samples directly on culture media.

More on Corneal Ulceration and Ulcerative Keratitis

Overview: Corneal Ulceration and Ulcerative Keratitis
Differential Diagnoses & Workup: Corneal Ulceration and Ulcerative Keratitis
Treatment & Medication: Corneal Ulceration and Ulcerative Keratitis
Follow-up: Corneal Ulceration and Ulcerative Keratitis
References

References

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  2. Efron N, Morgan PB, Hill EA, et al. Incidence and morbidity of hospital-presenting corneal infiltrative events associated with contact lens wear. Clin Exp Optom. Jul 2005;88(4):232-9. [Medline].

  3. Kehe K, Szinicz L. Medical aspects of sulphur mustard poisoning. Toxicology. Oct 30 2005;214(3):198-209. [Medline].

  4. Araki-Sasaki K, Nishi I, Yonemura N, et al. Characteristics of Pseudomonas corneal infection related to orthokeratology. Cornea. Oct 2005;24(7):861-3. [Medline].

  5. Clewes AR, Dawson JK, Kaye S, et al. Peripheral ulcerative keratitis in rheumatoid arthritis: successful use of intravenous cyclophosphamide and comparison of clinical and serological characteristics. Ann Rheum Dis. Jun 2005;64(6):961-2. [Medline].

  6. Frith P, Gray R, MacLennan S. The Eye in Clinical Practice. 1994:77-95.

  7. Goldberg DF, Negvesky GJ, Butrus SI, et al. Ulcerative keratitis in mycosis fungoides. Eye Contact Lens. Sep 2005;31(5):219-20. [Medline].

  8. Höfling-Lima AL, de Freitas D, Sampaio JL, et al. In vitro activity of fluoroquinolones against Mycobacterium abscessus and Mycobacterium chelonae causing infectious keratitis after LASIK in Brazil. Cornea. Aug 2005;24(6):730-4. [Medline].

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  10. Khanal B, Deb M, Panda A, et al. Laboratory diagnosis in ulcerative keratitis. Ophthalmic Res. May-Jun 2005;37(3):123-7. [Medline].

  11. Krachmer JH, Mannis MJ, Holland EJ. Cornea: Fundamentals of Cornea and External Disease. 1997:403-407.

  12. Leibowitz HM. Corneal Disorders: Clinical Diagnosis and Management. 1984:353-372.

  13. Mirza SH. Fungal keratitis due to fusarium solani. J Coll Physicians Surg Pak. Sep 2005;15(9):576-7. [Medline].

  14. O'Donnell C, Efron N. Contact lens wear and diabetes mellitus. Cont Lens Anterior Eye. 1998;21(1):19-26. [Medline].

  15. Pichare A, Patwardhan N, Damle AS, et al. Bacteriological and mycological study of corneal ulcers in and around Aurangabad. Indian J Pathol Microbiol. Apr 2004;47(2):284-6. [Medline].

  16. Pinna A, Sechi LA, Zanetti S, et al. Detection of virulence factors in a corneal isolate of Klebsiella pneumoniae. Ophthalmology. May 2005;112(5):883-7. [Medline].

  17. Seino JY, Anderson SF. Mooren's ulcer. Optom Vis Sci. Nov 1998;75(11):783-90. [Medline].

  18. Servat JJ, Ramos-Esteban JC, Tauber S, et al. Mycobacterium chelonae-Mycobacterium abscessus complex clear corneal wound infection with recurrent hypopyon and perforation after phacoemulsification and intraocular lens implantation. J Cataract Refract Surg. Jul 2005;31(7):1448-51. [Medline].

  19. Thomas JW, Pflugfelder SC. Therapy of progressive rheumatoid arthritis-associated corneal ulceration with infliximab. Cornea. Aug 2005;24(6):742-4. [Medline].

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  21. Velasco Cruz AA, Attie-Castro FA, Fernandes SL, et al. Adult blindness secondary to vitamin A deficiency associated with an eating disorder. Nutrition. May 2005;21(5):630-3. [Medline].

  22. Verhelst D, Koppen C, Van Looveren J, et al. Clinical, epidemiological and cost aspects of contact lens related infectious keratitis in Belgium: results of a seven-year retrospective study. Bull Soc Belge Ophtalmol. 2005;7-15. [Medline].

  23. Zaher SS, Sandinha T, Roberts F, et al. Herpes simplex keratitis misdiagnosed as rheumatoid arthritis-related peripheral ulcerative keratitis. Cornea. Nov 2005;24(8):1015-7. [Medline].

Further Reading

Keywords

corneal ulceration, ulcerative keratitis, corneal ulcer, peripheral ulcerative keratitis, PUK, corneal infiltrative events, CIEs, corneal ulcer disease, Mooren's ulcer, Mooren ulcer, corneal melt

Contributor Information and Disclosures

Author

Trevor John Mills, MD, MPH, Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Associate Professor of Emergency Medicine, Louisiana State University Health Sciences Center
Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Public Health Association, Society for Academic Emergency Medicine, Southern Medical Association, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Medical Editor

William K Chiang, MD, Associate Professor, Department of Emergency Medicine, Department of Emergency Medicine, New York University School of Medicine; Consulting Staff, Bellevue Hospital Center
William K Chiang, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Medical Toxicology, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Douglas Lavenburg, MD, Clinical Professor, Department of Emergency Medicine, Christiana Care Health Systems
Douglas Lavenburg, MD is a member of the following medical societies: American Society of Cataract and Refractive Surgery
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP, Program Director, Professor, Department of Emergency Medicine, Professor, Internal Medicine, University Hospitals, Case Western Reserve School of Medicine
Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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