Mooren’s Ulcer

Definition

Mooren’s ulcer is a painful peripheral ulcerative keratitis (PUK) with no associated scleritis and systemic disorder that may be considered responsible for the progressive destruction of the cornea. The disease generally begins with intense inflammation of the limbus, episclera and conjunctiva. The ulcers leave behind either an opaque, oedematous central cornea.

Characteristics of Mooren’s Ulcer

• Idiopathic condition
• Ulcers are crescent-shaped
• First appears as grey swellings
• Rapidly progressive
• Rare disorder
• Affect one or both eyes
• Initially affects the peripheral cornea and may spread circumferentially and then centrally

Affected population

• More common in men
• Patients tend to be affected between their sixth and eighth decades of life

Cause of Mooren’s ulcer

Although the cause of Mooren’s ulcer is not known, but it is linked with the presence of any autoimmune disease that is directed against a specific target molecule in the corneal stroma. Recent research has also proposed its possible association with the hepatitis C virus.

Risk Factors of Mooren’s ulcer

• Corneal surgery
• Previous trauma
• Infection (hookworm infection)
• Foreign bodies in the eye
• Chemical burns
• Genetics

Clinical types of Mooren’s ulcer

Unilateral Mooren’s ulceration (UM):

• Unilateral
• Excessively painful progressive corneal ulceration
• Tends to occur in older patient

Bilateral aggressive Mooren’s ulceration (BAM):

• Bilateral
• Progresses circumferentially and, only later, centrally in the cornea
• Occur more in younger patients

Bilateral indolent Mooren’s ulceration (BIM):

• Bilateral
• Progressive peripheral corneal guttering in both eyes, with little inflammatory response
• Occurs in middle-aged patients

Symptoms of Mooren’s ulcer

• Intense and incapacitating pain in the eye
• Eye redness
• Excessive tearing
• Photophobia
• Decreased visual acuity
• Scarred, vascularized and thin cornea

Diagnosis of Mooren’s ulcer

Mooren’s ulcer is an idiopathic disorder and all its characteristic symptoms occur in the absence of any systemic disease or infection. Thus, it is a diagnosis of exclusion.

Treatment of Mooren’s ulcer

A step-wise approach to arrest the destructive process and, promote healing and reepithelialisation of the corneal surface is followed to manage Mooren’s ulcer that constitutes of the following:

• Topical or oral steroids
• Conjunctival resection
• Systemic immunosuppressive
• Additional surgical procedure like
  • Penetrating keratoplasty
  • Superficial lamellar keratectomy
• Rehabilitative surgical therapy in two stages: Initial lamellar tectonic grafting and central penetrating keratoplasty

Complications from Mooren’s ulcer

• Iritis
• Hypopyon
• Glaucoma
• Cataract
• Perforation