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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