MOOREN'S ULCER

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The Mooren's ulcer (chronic serpiginous or rodent ulcer) is a severe inflammatory peripheral ulcerative keratitis.

Etiology
Exact etiology is not known. Different views are :
1. It is an idiopathic degenerative conditon.
2. It may be due to an ischaemic necrosis resulting from vasculitis of limbal vessels.
3. It may be due to the effects
of enzyme collagenase and proteoglyconase produced from conjunctiva.
4. Most probably it is an autoimmune disease (antibodies against corneal epithelium have been demonstrated in serum).

Clinical picture
Two clinical varieties of Mooren's ulcer have been
recognised.
1. Benign form which is usually unilateral, affects the elderly people and is characterised by a relative slow progress.
2. Virulent type also called the progressive form is bilateral, more often occurs in younger patients.
The ulcer is rapidly progressive with a high incidence of scleral involvement.

Symptoms. These include severe pain, photophobia,
lacrimation and defective vision.

Signs. Features of Mooren's ulcer are shown in Fig. 1.

Fig. 1. Mooren's ulcer : A, diagrammatic depiction;
B, clinical photograph

• It is a superficial ulcer which starts at the corneal margin as patches of grey infiltrates which coalesce to form a shallow furrow over the whole cornea.
• The ulcer undermines the epithelium and superficial stromal lamellae at the advancing border, forming a characteristic whitish overhanging edge. Base of the ulcer soon becomes vascularized. The spread may be selflimiting or progressive.
• The ulcer rarely perforates and the sclera remains
  uninvolved.

 Treatment

Since exact etiology is still unknown, its treatment is highly unsatisfactory. Following measures may be tried:
1. Topical corticosteroids instilled every 2-3 hours are tried as initial therapy with limited success.

2. Immunosuppressive therapy with systemic steroids may be of help. Immunosuppression with cyclosporin or other cytotoxic agents may be quite useful in virulent type of disease.

3. Soft contact lenses have also been used with some relief in pain.

4. Lamellar or full thickness corneal grafts often melt or vascularize.

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