Rheumatoid-associated Peripheral Ulcerative Keratitis

Rheumatoid arthritis-associated peripheral ulcerative keratitis. 

  • Occasionally develops in patients who have systemic autoimmune disease such as rheumatoid arthritis, polyarthritis nodosa, ulcerative colitis, systemic lupus erithematosus, systemic vasculitis and Wegener's granulomatosis.

Clinical features:

  • History of connective tissue disease.
  • Corneal finding may precede other systemic signs.
  • Symptoms are not specific, including:
    • Foreign body sensation
    • Pain
  • Signs:
    • Maybe bilateral, but most commonly unilateral
    • Peripheral corneal furrowing or melting
    • Stromal thinning
    • Sterile infiltrate may be present
    • Maybe associated with mildly inflamed conjunctiva
    • Descemetocele in progressive keratolysis
    • May be complicated with corneal perforation

Treatment goal:

  • Arresting the melting or keratolysis process
  • Maintaining the integrity of the eye

Management:

  • Consult the rheumatologist to ensure adequate systemic immunosuppressant treatment for systemic disease.
  • Promote re-epithelialization by ocular surface lubrication, patching or bandage soft contact lens.
  • Topical or systemic collagenase inhibitor.
  • Cautious use of topical corticosteroid.
  • Cyanoacrylate glue protected with bandage soft contact lens for impending perforation case.
  • Conjunctival recession.
  • Conjunctival flap should be avoided as first line surgery.