Peripheral ulcerative keratitis due to systemic diseases

Abstract

Purpose of reviewTo discuss peripheral ulcerative keratitis, with a focus on the evaluation and management of associated systemic diseases.Recent findingsPeripheral ulcerative keratitis (PUK) is a sight-threatening condition that is often defined by the presence of a crescent-shaped area of peripheral corneal thinning, an epithelial defect, and an inflammatory corneal infiltrate. It is highly associated with rheumatoid arthritis, systemic necrotizing vasculitides like granulomatosis with polyangiitis, and collagen vascular diseases like systemic lupus erythematosus. Undertreated PUK carries a risk of vision loss and premature death.SummaryMultidisciplinary collaboration between the ophthalmologist, rheumatologist, and other consultants is required. Early and aggressive steroid-sparing therapy should be considered in cases due to noninfectious systemic disease.

Peripheral Ulcerative Keratitis Associated With Lichen Planus

“…We hypothesize this could be similar to other autoimmune T-cell-mediated conditions, such as rheumatoid arthritis. 3 We did not consider a conjunctival biopsy in this case because the patient already had a confirmed histology of oral lichen planus and the ocular surface had no signs of cicatricial conjunctivitis. Conjunctival biopsy could be more useful to confirm diagnosis of lichen planus and rule out ocular mucous membrane pemphigoid.…”

“…2 The pathogenesis of PUK is not fully known; however, it is believed to be mediated by cell-mediated and humoral immunity and it may represent worsening of a potentially life-threatening disease. 2,3…”

“…2 The pathogenesis of PUK is not fully known; however, it is believed to be mediated by cell-mediated and humoral immunity and it may represent worsening of a potentially life-threatening disease. 2,3 Early treatment is imperative in PUK to prevent perforation and to preserve eye integrity and vision. However, often treatment may be delayed as etiological diagnosis of PUK can be challenging in the absence of a known disease associated with corneal melting.…”

Rheumatoid Arthritis Associated with Dry Eye Disease and Corneal Surface Damage: A Nationwide Matched Cohort Study

“…Current evidence suggests that lymphocyte and plasma cell infiltration in cornea and lacrimal gland destruction are possibly responsible for RA-associated DED [ 34 ]. In addition, destructive inflammatory cells in the marginal corneal cause progressive stromal degradation and thinning, corneal perforation, and ulceration [ 15 , 16 ]. Both T cells and antibodies associated with RA are involved in the corneal inflammation [ 35 ].…”

“…Common ocular manifestations of RA include corneal inflammation, lacrimal gland dysfunction, and uveitis, sharing similar pathogenic mechanisms to DED [ 15 ]. Noticeably, studies have shown that DED is more likely to progress into corneal erosion and ulcers among patients with systemic autoimmune diseases [ 15 , 16 ].…”