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Ulcus Rodens!

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⁣⁣⁣




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: ⁣⁣⁣


● 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⁣⁣⁣



● 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⁣⁣⁣



● 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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