Review Article

Peripheral ulcerative keratitis: A review of aetiology and management

Roland Hӧllhumer
African Vision and Eye Health | Vol 81, No 1 | a697 | DOI: https://doi.org/10.4102/aveh.v81i1.697 | © 2022 Roland Hollhumer | This work is licensed under CC Attribution 4.0
Submitted: 02 August 2021 | Published: 13 January 2022

About the author(s)

Roland Hӧllhumer, Department of Neurosciences, Faculty of Ophthalmology, University of the Witwatersrand, Johannesburg, South Africa


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Abstract

Background: Peripheral ulcerative keratitis (PUK) is a severe inflammatory disease of the peripheral cornea that can be caused by local factors or systemic inflammatory disease.

Aim: The purpose of this review is to give an overview of the pathophysiology, aetiology, clinical features, diagnosis, and management of PUK.

Method: A PubMed search was conducted using the keywords, ‘peripheral ulcerative keratitis’ and ‘Mooren’s ulcer’.

Results: The peripheral cornea has unique characteristics the predispose to the development of PUK. These include fine capillary arcades that allow for deposition of immune complexes and subsequent activation of an inflammatory cascade with corneal melt. Several conditions have been implicated in the aetiology of PUK. The most commonly cited causes are rheumatoid arthritis (RA), granulomatosis with polyangiitis (GPA) and various dermatoses. In patients with RA, PUK usually presents in established disease, whereas in GPA, PUK may be the presenting feature in up to 60% of cases. In RA it heralds the onset of a systemic vasculitis with significant associated morbidity and mortality. The management of PUK follows an individualised stepwise approach. All patients require supportive measures to encourage healing and halt the process of keratolysis. Systemic autoimmune conditions need a systemic corticosteroid as a fast-acting agent to halt the inflammatory process while cytotoxic therapy maintains long term disease control. Failure to achieve disease control with CTT, necessitates the use of a biologic agent.

Conclusion: Peripheral ulcerative keratitis is a severe inflammatory disease of the peripheral cornea that needs a thorough diagnostic workup and stepwise management approach.


Keywords

peripheral ulcerative keratitis; immunosuppression; cytotoxic therapy; biologic therapy; rheumatoid arthritis; granulomatosis with polyangiitis

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