Peripheral Ulcerative Keratitis Workup

Updated: Jun 11, 2019
  • Author: Ellen N Yu-Keh, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Workup

Laboratory Studies

Laboratory tests used to evaluate peripheral ulcerative keratitis (PUK) should focus on the suspected systemic disease, as follows: [4]

  • Complete blood cell (CBC) count
  • Urinalysis (UA), blood urea nitrogen (BUN), and creatinine
  • Erythrocyte sedimentation rate (ESR)
  • Rheumatoid factor (RF); positive in 80% of patients with associated RA [4, 25]
  • Angiotensin-converting enzyme (ACE); elevated in sarcoidosis
  • Antinuclear antibodies (ANA); positive in patients with SLE and RA
  • Antibody to double-stranded DNA (anti-dsDNA); associated with SLE
  • Antibodies to small nuclear ribonucleoprotein-Sm (anti-Sm); associated with SLE
  • Antibodies to small nuclear ribonucleoproteins-RNP (anti-RNP); associated with SLE
  • Antineutrophil cytoplasmic antibodies (ANCA); C-ANCA sensitivity of 96% for active generalized GPA, 67% for active regional disease, and 32% for GPA in full remission after initial regional symptoms [4, 6, 26, 27, 28]
  • Circulating immune complex (CIC) - Raji cell assay; C-1q binding assay
  • Anti-type II antibodies; associated with RP
  • Complement - C3 and C4, CH50; consumed in patients with SLE
  • Hepatitis B surface antigen (HBsAg); present in 40% of patients with PAN
  • Fluorescent treponemal antibody-absorption (FTA-ABS) for syphilis
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Imaging Studies

Local

Anterior-segment optical coherence tomography (OCT) may be used to document baseline corneal thickness and to monitor for progressive thinning. [29]

Systemic

Chest radiography and sinus CT scanning may be used to rule out GPA, sarcoidosis, and tuberculosis.

Radiography of affected joints may be performed.

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Procedures

Scraping and culture of the ulcer are recommended.

Conjunctival resection/biopsy may be helpful in removing the limbal source of collagenases and other factors causing progressive ulceration.

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Histologic Findings

In Mooren ulcer, corneal thickening occurs at the margin of the ulcer where inflammatory cells have invaded the anterior stromal layers. However, the inflammation is nonspecific, and no etiologic agent can be identified. Necrosis of the involved epithelium and stroma is seen. PUK associated with connective tissue disease and PUK associated with mild infections sometimes may appear similarly. Signs of vasculitis in the adjacent conjunctiva may be seen. [30]

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