Mooren’s ulcer

MOOREN’S ULCER

K. Bhuvaneshwari

It is a rare, degenerative, superficial ulcer, starting at the corneal margin and spreading circumferentially and axially over the whole of this tissue.

It is a rapidly progressive, painful, ulcerative keratitis

It can be only be diagnosed in the absence of systemic cause and must be differentiated from other corneal abnormlities such as, Terriens degeneration.

Types BENIGN /TYPICAL

Unilateral

Reponds well to treatment

Elderly people

MALIGNANT

Bilateral

Very poorly responds to treatment

Younger people

progressive

CAUSE

It is an auto immune disorder. Associated with infections-

helminthiasis, hepatitis C, herpes simplex and zoster.

Various theories The antigen antibody reaction to

infectious toxin deposited in the peripheral cornea causes inflammation and ulceration.

Molecular mimicry may be involved, stimulating an auto immune response.

Deposition of immune complex over peripheral cornea

Other causes: Physical trauma, foreign bodies,

chemical burns, surgeries such as cataract extraction and keratoplasty.

Pathophysiology

Auto immune lysis of the epithelium with release of collagenolytic enzymes.

Grey infiltrates , which break down, forming small ulcers that spread and coalesce.

It destroys the epithelium and superficial stromal lamellae, forming a whitish overhanging edge, while the base quickly becomes vascularised.

Symptoms

severe and persistent neuralgic pain.

RednessPhotophobiaLacrimationDecrease in visual acuity due to

associated iritis, central corneal involvement and irregular astigmatism.

investigations

CBC with differentials ESR RF Complement fixation ANA,ANCA & circulating immune

complexes VDRL, FTA-ABS Urine analysis

TREATMENT Topical steroids and antibiotics Excision of a 4-7 mm strip of adjacent

conjunctiva may prove successful by eliminating conjunctival sources of collagenase , proteoglycanase and other inflammatory mediators.

Perforation: ulcer debridement cyanoacrylate adhesive soft contact lenses. Lamellar keratoplasty with i.v

methotrexate – halt the process

Thank you