Peripheral ulcerative keratitis - External and Internal Eye
Alerts and Notices
Synopsis
- Rheumatoid arthritis
- Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitidies:
- Granulomatosis with polyangiitis
- Polyarteritis nodosa
- Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
- Microscopic polyangiitis
- Inflammatory bowel disease
- Systemic lupus erythematosus
- Relapsing polychondritis
PUK affects 3 persons per million per year. There is no gender predilection, but PUK more commonly affects patients after their fourth or fifth decade.
Patients present with ocular redness, pain, tearing, photophobia, and decreased vision. The classic presentation is a crescent-shaped white ulcer on the peripheral edge of the cornea.
Cases are mostly unilateral but can be bilateral. About 36%-66% of PUK cases can be associated with a scleritis, and a wider incidence of cases can be associated with anterior uveitis. The worst complications of PUK are corneal perforation or scleral perforation from an associated necrotizing scleritis. These complications need immediate surgical intervention to prevent infection and vision loss.
Codes
ICD10CM:H16.009 – Unspecified corneal ulcer, unspecified eye
SNOMEDCT:
416473005 – Peripheral ulcerative keratitis
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
Corneal degenerations:- Terrien's marginal degeneration
- Pellucid marginal degeneration
- Furrow degeneration
- Staphylococcal marginal keratitis (see bacterial keratitis)
- Phlyctenular keratoconjunctivitis
- Vernal keratoconjunctivitis
- Infectious ulcers (see bacterial corneal ulcer, fungal corneal ulcer)
- Mooren ulcer (can be associated with hepatitis C virus infection)
- Exposure keratopathy
- Neurotrophic keratoconjunctivitis
- Trauma
- Surgical complications
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:01/21/2021
Last Updated:01/21/2021
Last Updated:01/21/2021
Peripheral ulcerative keratitis - External and Internal Eye