Cornea/Refractive Surgery Quiz 14

Yichieh Shiuey, MD | Massachusetts Eye and Ear Infirmary, Harvard Medical School

January 7, 1997
Figure 1
This is the painful left eye of a woman with a chronic history of arthritis and skin rash. (photograph courtesy of C. Stephen Foster, MD)
Questions and Answers
1. What is the name for this type of corneal condition.
Answer: Peripheral ulcerative keratitis

2. What systemic diseases is this type of condition associated with?
Answer: Rheumatoid arthritis, Wegener's granulomatois, polyarteritis nodosa, relapsing polychondritis, and systemic lupus erythematosus

3. What is the pathophysiology of this condition?
Answer: The pathophysiology is the same as for the vasculitis which occurs with the above collagen vascular diseases. Immune complexes are deposited in the cornea with subsequent chemotaxis of inflammatory cells including plasma cells, histiocytes, lymphocytes, and eosinophils. These inflammatory cells then release degradative enzymes which melt the cornea.

4. What is the prognostic significance of these corneal findings?
Answer: Peripheral ulcerative keratitis and scleritis in the setting of collagen vascular disease is a marker for severe systemic vasculitis. Untreated these patients have a high mortality rate.

5. What is the treatment for this type of condition?
Answer: Systemic treatment with immunosuppressives is the most important therapy for patients with collagen vascular disease and peripheral ulcerative keratitis. Local measures include wide conjunctival resection, ulcer debridement, application of tissue adhesives, and the use of bandage contact lenses. Local therapy often fails in the absence of systemic immunosuppression.