Rheumatoid-Associated Peripheral Ulcerative Keratitis
- Occasionally develops in patients who have systemic autoimmune disease such as rheumatoid arthritis, polyarthritis nodosa, ulcerative colitis, systemic lupus erithematosus, systemic vasculitis, and Wegener's granulomatosis.
Clinical Features
- History of connective tissue disease.
- Corneal finding may precede other systemic signs.
- Symptoms are not specific, including:
- Foreign body sensation
- Pain
- Signs:
- Maybe bilateral, but most commonly unilateral
- Peripheral corneal furrowing or melting
- Stromal thinning
- Sterile infiltrate may be present
- May be associated with mildly inflamed conjunctiva
- Descemetocele in progressive keratolysis
- May be complicated with corneal perforation
Treatment Goals
- Arresting the melting or keratolysis process
- Maintaining the integrity of the eye
Management
- Consult the rheumatologist to ensure adequate systemic immunosuppressant treatment for systemic disease.
- Promote re-epithelialization by ocular surface lubrication, patching or bandage soft contact lens.
- Topical or systemic collagenase inhibitor.
- Cautious use of topical corticosteroid.
- Cyanoacrylate glue protected with bandage soft contact lens for impending perforation case.
- Conjunctival recession.
- Conjunctival flap should be avoided as first line surgery.
