Sections

Sections Peripheral Ulcerative Keratitis
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
Follow-up
Questions & Answers
Media Gallery
References

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

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.

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.

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]

Treatment & Management

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Media Gallery

Peripheral ulcerative keratitis in the right eye of a patient with rheumatoid arthritis. Cyanoacrylate glue has been placed.
Same patient as in previous image, 1 year posttreatment.
Left eye of same patient as in previous images. Note the corneal thinning and scarring.

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Author

Ellen N Yu-Keh, MD Consulting Staff, Department of Ophthalmology, St Luke's Medical Center, Quezon City, Philippines

Ellen N Yu-Keh, MD is a member of the following medical societies: Philippine Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

C Stephen Foster, MD, FACS, FACR, FAAO, FARVO Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary; Founder and President, Ocular Immunology and Uveitis Foundation, Massachusetts Eye Research and Surgery Institution

C Stephen Foster, MD, FACS, FACR, FAAO, FARVO is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Association of Immunologists, American College of Rheumatology, American College of Surgeons, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, American Uveitis Society, Association for Research in Vision and Ophthalmology, Massachusetts Medical Society, Royal Society of Medicine, Sigma Xi, The Scientific Research Honor Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Aldeyra Therapeutics (Lexington, MA); Bausch & Lomb Surgical, Inc (Rancho Cucamonga, CA); Eyegate Pharma (Waltham, MA); Novartis (Cambridge, MA); pSivida (Watertown, MA); Xoma (Berkeley, CA); Allakos (Redwood City, CA) Serve(d) as a speaker or a member of a speakers bureau for: Alcon (Geneva, Switzerland); Allergan (Dublin, Ireland); Mallinckrodt (Staines-upon-Thames, United Kingdom) Received research grant from: Alcon; Aldeyra Therapeutics; Allakos Pharmaceuticals; Allergan; Bausch & Lomb; Clearside Biomedical; Dompé pharmaceutical; Eyegate Pharma; Mallinckrodt pharmaceuticals; Novartis; pSivida; Santen; Aciont Stock for: Eyegate Pharma.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Sidney Kimmel Medical College of Thomas Jefferson University; Director of the Cornea Service, Wills Eye Hospital

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Ophthalmological Society, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: AAO; OMIC; American Society of Ophthalmic Trauma (ASOT); Avellino, Baxis; Bio-Tissue; Celularity; Dompe; Emmecell; Glaukos; Kala; Oyster Point; Sun Ophthalmics; Tarsus; TearLab Serve(d) as a speaker or a member of a speakers bureau for: Glaukos; Dompe; Bio-Tissue Received research grant from: Glaukos Received income in an amount equal to or greater than $250 from: AAO; OMIC; Baxis; Bio-Tissue; Cellularity; Dompe; Glaukos; Kala; Sun Ophthalmics; TearLab stock options for: RPS, Fount Bio.

Chief Editor

Andrew A Dahl, MD, FACS Assistant Professor of Surgery (Ophthalmology), New York College of Medicine (NYCOM); Director of Residency Ophthalmology Training, The Institute for Family Health and Mid-Hudson Family Practice Residency Program; Staff Ophthalmologist, Telluride Medical Center

Andrew A Dahl, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Intraocular Lens Society, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Medical Society of the State of New York, New York State Ophthalmological Society, Outpatient Ophthalmic Surgery Society

Disclosure: Nothing to disclose.

Additional Contributors

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.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Lijing Yao, MD, to the development and writing of this article.

Sections Peripheral Ulcerative Keratitis
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
Follow-up
Questions & Answers
Media Gallery
References

Peripheral Ulcerative Keratitis Workup

Laboratory Studies

Imaging Studies

Local

Systemic

Procedures

Histologic Findings

Peripheral Ulcerative Keratitis Workup

Laboratory Studies

Imaging Studies

Local

Systemic

Procedures

Histologic Findings

References

Tables

Contributor Information and Disclosures

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