𝐌𝐨𝐨𝐫𝐞𝐧’𝐬 𝐔𝐥𝐜𝐞𝐫
● Mooren’s is a chronic, progressive and painful peripheral ulcerative keratitis of idiopathic/unknown etiology and no systemic associations.
● First described by Boman and McKenzie in 1854 as ‘chronic serpiginous ulcer/ ulcus rodens’
● Autoimmune process - a Type 3 hypersensitivity reaction has been implicated - antigen antibody reaction to infectious toxin deposited in the peripheral cornea causes inflammation and ulceration
● More common in adult males
● Infectious associations have been reported- helminthiasis, hepatitis C
𝐓𝐲𝐩𝐞𝐬:
1. Limited/Typical
Unilateral, older patients, mild to moderate symptoms, responded well to medical and surgical treatment
2. Malignant/Atypical
Bilateral, younger patients, severe symptoms, poor response to therapy
𝐂𝐥𝐢𝐧𝐢𝐜𝐚𝐥 𝐟𝐞𝐚𝐭𝐮𝐫𝐞𝐬:
𝘚𝘺𝘮𝘱𝘵𝘰𝘮𝘴:
● Pain is excruciating - out of proportion to the inflammation
● Redness, lacrimation, photophobia
● Reduced vision - irregular astigmatism due to peripheral corneal thinning, associated
uveitis, central corneal involvement
𝘚𝘪𝘨𝘯𝘴:
● Progressive, peripheral, crescentic corneal ulceration that is slightly central to the corneoscleral limbus
● Patchy peripheral stromal infiltrates → Coalesce → spreads circumferentially and then centrally → involves limbus and entire cornea eventually
● Anterior 1⁄3 to 1⁄2 of corneal stroma involved with a STEEP, OVERHANGING EDGE
● Leading and central edge is typically UNDERMINED
● Adjacent conjunctiva - inflamed
● Sclera is not involved
● Chronic disease → healing and vascularisation occurs over 4-18 months
● End stage is a scarred and vascularised cornea that may be thinned to less than half of its original thickness
𝘊𝘰𝘮𝘱𝘭𝘪𝘤𝘢𝘵𝘪𝘰𝘯𝘴:
● Iritis/Uveitis
● Hypopyon
● Glaucoma
● Cataract
● Perforation due to even minor trauma
𝐌𝐀𝐍𝐀𝐆𝐄𝐌𝐄𝐍𝐓 𝐚𝐧𝐝 𝐓𝐑𝐄𝐀𝐓𝐌𝐄𝐍𝐓 𝐰𝐢𝐥𝐥 𝐛𝐞 𝐝𝐢𝐬𝐜𝐮𝐬𝐬𝐞𝐝 𝐢𝐧 𝐝𝐞𝐭𝐚𝐢𝐥 𝐢𝐧 𝐭𝐡𝐞 𝐧𝐞𝐱𝐭 𝐩𝐨𝐬𝐭!
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