Summary

Peripheral ulcerative keratitis describes a group of inflammatory diseases involving the peripheral cornea. It is associated with autoimmune conditions such as rheumatoid arthritis, lupus and granulomatosis with polyangiitis. Symptoms include pain, redness, tearing, photophobia and decreased visual acuity. Signs include crescent-shaped damage of the cornea. Prompt diagnosis and treatment are essential to prevent complications and preserve vision.

Aetiology

Peripheral ulcerative keratitis is associated with chronic autoimmune diseases such as:

• Rheumatoid arthritis
• Systemic lupus erythematosus
• Granulomatosis with polyangiitis
• Relapsing polychondritis

These autoimmune disease can lead to an inflammatory response that can affect the cornea, leading to peripheral ulcerative keratitis.

Other conditions that can cause peripheral ulcerative keratitis include infectious diseases such as herpes simplex virus, varicella-zoster virus, and bacterial infections.

In some cases, peripheral ulcerative keratitis can be idiopathic.

Risk factors for developing PUK include a history of autoimmune disease, recent eye surgery or injury, contact lens use, and exposure to certain medications such as topical prostaglandins.

Clinical features

The clinical features of peripheral ulcerative keratitis typically involve inflammation and ulceration of the peripheral cornea. The condition can affect one or both eyes, and symptoms can vary in severity depending on the underlying cause and stage of the disease.

Common symptoms include:

• Blurred vision: corneal inflammation and ulceration can cause loss of visual acuity, causing vision to become blurry.
• Pain: peripheral ulcerative keratitis can cause moderate to severe eye pain, which may be described as a burning or stinging sensation.
• Photophobia: the eyes may be sensitive to light, causing discomfort in bright environments.