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Hassanpour K, ElSheikh RH, Arabi A, Frank CR, Elhusseiny AM, Eleiwa TK, Arami S, Djalilian AR, Kheirkhah A. Peripheral Ulcerative Keratitis: A Review. JOVR [Internet]. 2022Apr.29 [cited 2024Apr.19];17(2):252–275. Available from: https://knepublishing.com/index.php/JOVR/article/view/10797
https://doi.org/10.18502/jovr.v17i2.10797
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authors
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Kiana Hassanpour
Kiana Hassanpour
Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Reem H. ElSheikh
Reem H. ElSheikh
Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Amir Arabi
Amir Arabi
Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Charles R. Frank
Charles R. Frank
Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
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Abdelrahman M. Elhusseiny
Abdelrahman M. Elhusseiny
Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
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Taher K. Eleiwa
Taher K. Eleiwa
Department of Ophthalmology, Faculty of Medicine, Benha University, Benha, Egypt
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Shiva Arami
Shiva Arami
Department of Medicine, Division of Rheumatology, University of Illinois at Chicago, Chicago, IL, USA
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Ali R. Djalilian
Ali R. Djalilian
Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
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Ahmad Kheirkhah
Ahmad Kheirkhah
Department of Ophthalmology, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA
Published Date
- Apr 29, 2022
Peripheral Ulcerative Keratitis: A Review
Abstract
Peripheral ulcerative keratitis (PUK) is a rare but serious ocular condition that is an important clinical entity due to its ophthalmological and systemic implications. It is characterized by progressive peripheral corneal stromal thinning with an associated epithelial defect and can be associated with an underlying local or systemic pro-inflammatory condition, or present in an idiopathic form (Mooren ulcer). Associated conditions include autoimmune diseases, systemic and ocular infections, dermatologic diseases, and ocular surgery. Cell-mediated and autoantibody- mediated immune responses have been implicated in the pathogenesis of PUK, destroying peripheral corneal tissue via matrix metalloproteinases. Clinically, patients with PUK present with painful vision loss, a peripheral corneal ulcer, and often adjacent scleritis, episcleritis, iritis, or conjunctivitis. Diagnostic evaluation should be focused on identifying the underlying etiology and ruling out conditions that may mimic PUK, including marginal keratitis and Terrien marginal degeneration. Treatment should be focused on reducing local disease burden with topical lubrication, while simultaneously addressing the underlying cause with antimicrobials or anti-inflammatory when appropriate. Existing and emerging biologic immunomodulatory therapies have proven useful in PUK due to autoimmune conditions. Surgical treatment is generally reserved for cases of severe thinning or corneal perforation.
Keywords:
Autoimmune Disease, Immunomodulatory Therapy, Ulcerative Keratitis
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