Peripheral ulcerative keratitis: A review of aetiology and management
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, a...
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| Format: | Article |
| Language: | English |
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AOSIS
2022-01-01
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| Series: | African Vision and Eye Health |
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| Online Access: | https://avehjournal.org/index.php/aveh/article/view/697 |
| _version_ | 1818897262416232448 |
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| author | Roland Hӧllhumer |
| author_facet | Roland Hӧllhumer |
| author_sort | Roland Hӧllhumer |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-19T19:13:23Z |
| format | Article |
| id | doaj.art-0f45fc5679914a7cbbafac7ca2d53cb7 |
| institution | Directory Open Access Journal |
| issn | 2413-3183 2410-1516 |
| language | English |
| last_indexed | 2024-12-19T19:13:23Z |
| publishDate | 2022-01-01 |
| publisher | AOSIS |
| record_format | Article |
| series | African Vision and Eye Health |
| spelling | doaj.art-0f45fc5679914a7cbbafac7ca2d53cb72022-12-21T20:09:12ZengAOSISAfrican Vision and Eye Health2413-31832410-15162022-01-01811e1e1110.4102/aveh.v81i1.697490Peripheral ulcerative keratitis: A review of aetiology and managementRoland Hӧllhumer0Department of Neurosciences, Faculty of Ophthalmology, University of the Witwatersrand, JohannesburgBackground: 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.https://avehjournal.org/index.php/aveh/article/view/697peripheral ulcerative keratitisimmunosuppressioncytotoxic therapybiologic therapyrheumatoid arthritisgranulomatosis with polyangiitis |
| spellingShingle | Roland Hӧllhumer Peripheral ulcerative keratitis: A review of aetiology and management African Vision and Eye Health peripheral ulcerative keratitis immunosuppression cytotoxic therapy biologic therapy rheumatoid arthritis granulomatosis with polyangiitis |
| title | Peripheral ulcerative keratitis: A review of aetiology and management |
| title_full | Peripheral ulcerative keratitis: A review of aetiology and management |
| title_fullStr | Peripheral ulcerative keratitis: A review of aetiology and management |
| title_full_unstemmed | Peripheral ulcerative keratitis: A review of aetiology and management |
| title_short | Peripheral ulcerative keratitis: A review of aetiology and management |
| title_sort | peripheral ulcerative keratitis a review of aetiology and management |
| topic | peripheral ulcerative keratitis immunosuppression cytotoxic therapy biologic therapy rheumatoid arthritis granulomatosis with polyangiitis |
| url | https://avehjournal.org/index.php/aveh/article/view/697 |
| work_keys_str_mv | AT rolandhöllhumer peripheralulcerativekeratitisareviewofaetiologyandmanagement |