FACE AND FACIAL SYMMETRY
Blepharospasm due to pain
CONJUNCTIVA & EPI SCLERA
Intense Limbal inflammation and swelling in the episclera and conjunctiva.
SCLERA
The disease does not affect the sclera.
CORNEA
There is a temporal peripheral corneal ulcer (guttering) involving the stroma and the epithelium. The ulcer extends circumferentially. The epithelial defect has an overhanging edge with vascularization of the ulcer base. The conjunctiva is inflamed.
Corneal changes begin within 2-3 mm from the limbus, first appearing as grey swellings that rapidly furrow, affecting the superficial one-third of the cornea and then proceeding circumferentially and centrally over 4-12 months.
The bed of the furrow becomes vascularized, with vessels advancing into the base of the undermined edges of the ulcers
These ulcers are often described as crescent-shaped and can leave behind an opaque and edematous central cornea. Alternatively, they can completely consume the corneal stroma, replacing it with a thin fibrovascular membrane.
Inflammation is not seen in the sclera adjacent to the peripheral ulcers, nor does it affect the underlying Descemet’s membrane.
ANTERIOR CHAMBER
Anterior uveitis – 6.4%
IRIS AND PUPIL
LENS
Cataract 2.3%
SYSTEMIC CONDITIONS
Look for signs of
RA (arthropathy of the hands)
SLE (butterfly rash on the face)
Even when Mooren’s Ulcer seems to be the cause, always send for auto-immune screening and Swabs for Microculture.
Question:
Is making a clinical diagnosis of Mooren’s Ulcer enough?
Even when Mooren’s Ulcer seems to be the cause, always send for auto-immune screening and Swabs for Microculture.
How can Mooren's ulcer be treated?
There is no consensus, but the following strategies have been used: topical steroids, contact lenses, collagenase inhibitors such as acetylcysteine, topical cyclosporine A limbal conjunctival excision lamellar keratoplasty, systemic immunosuppressives such as steroid, cyclophosphamide, and cyclosporin.
How do you differentiate Mooren's ulcer from Terrien's degeneration?
Mooren's ulcer is an auto-immune disorder with ulceration of the epithelium and stroma. The condition is painful. Whereas Terrien's degeneration is a painless disorder, with thinning of the stroma. It begins superiorly and spreads circumferentially. There is a fine vascular pannus transversing the area of stromal thinning, and a line of lipid deposits appears at the leading edge of the pannus. There is usually a high against-the-rule astigmatism.
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