This condition is critical to recognize because it can quickly produce progressive necrosis of the corneal stroma, leading to perforation and blindness.
VISUAL ACUITY
It is reduced due to irregular astigmatism.
FACE AND FACIAL SYMMETRY
Saddle Shaped deformity of nose (due to destruction of nasal cartilage) Wegener’s Granulomatosis & Relapsing Polychondritis
Ear deformity – Relapsing Polychondritis
CONJUNCTIVA
Conjunctival inflammation, along with underlying scleral involvement, is seen.
CORNEA
In the early stages, infiltration of the peripheral cornea is seen along with conjunctival hyperemia.
Later, crescenteric juxta limbal corneal ulceration with equal-sized epithelial defect and stromal thinning is seen. The spread is circumferential and occasionally central.
360-degree peripheral ulceration may lead to contact lens cornea.
Descemetocele
Perforation
SCLERA
PUK, accompanied by necrotizing scleritis, almost always indicates the presence of a potentially lethal systemic disease.
36% of patients have Scleritis
Scleritis, Episcleritis, and limbitis are usually present in PUK (Absent in cases of Terrien and Mooren’s ulcer)
ANTERIOR CHAMBER
Depth
Reaction
POSTERIOR SEGMENT
Vasculitis & Optic Neuropathy – Connective tissue disorder
FELLOW EYE
Unilateral – Mooren’s Ulcer
Bilateral – Terrien, PUK – 21% of cases
SYSTEMIC CONDITIONS
General - Constitutional symptoms, such as chills, fever, poor appetite, recent weight loss, and fatigue
Skin - Rashes, nodules, vesicles, ulcers, nail changes, and periungual infarcts
Respiratory - Coughing, wheezing, pneumonia, and shortness of breath
Cardiac - Chest pain or discomfort and dyspnea
Gastrointestinal - Abdominal pain, nausea, vomiting, difficulty swallowing, and diarrhea
Musculoskeletal - Muscle or joint pain, arthritis, back pain, and limitation of motion
Neurologic - Headaches, seizures, psychiatric, paralysis, and numbness/tingling
Other systemic symptoms - Deafness, swollen ear lobes, ear infections, vertigo, and noises in ears (suggestive of RP)
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