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Peripheral Ulcerative Keratitis

(Marginal Keratolysis; Peripheral Rheumatoid Ulceration)

By

Melvin I. Roat

, MD, FACS, Sidney Kimmel Medical College at Thomas Jefferson University

Last full review/revision May 2020
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Topic Resources

Peripheral ulcerative keratitis is a serious eye disorder that involves inflammation and ulceration of the cornea (the clear layer in front of the iris and pupil) that often occurs in people who have connective tissue disorders such as rheumatoid arthritis.

  • Symptoms include blurred vision, increased sensitivity to bright light, and a sensation of a foreign object in the eye.

  • Doctors diagnose peripheral ulcerative keratitis based on the appearance of the cornea in someone who has a connective tissue disorder.

  • Doctors treat the damaged cornea and give drugs to suppress the immune system.

An Inside Look at the Eye

An Inside Look at the Eye

Peripheral ulcerative keratitis also may be caused by an infection.

Symptoms of Peripheral Ulcerative Keratitis

People develop blurred vision, increased sensitivity to bright light, and a sensation of a foreign object trapped in the eye. The ulcer is located in the margin of the cornea and is usually oval in shape.

Diagnosis of Peripheral Ulcerative Keratitis

  • A doctor's evaluation

  • Sometimes culture

The diagnosis of peripheral ulcerative keratitis is suspected when the doctor sees an affected cornea in a person who also has a severe and/or long-standing connective tissue disease.

If doctors suspect an infection, such as bacteria, fungi, or herpes simplex virus, is the cause of peripheral ulcerative keratitis, they scrape the ulcer and eyelid margins for a sample. The sample is then grown in a laboratory (cultured) to identify the organism.

Prognosis of Peripheral Ulcerative Keratitis

Without treatment, about 40% of people who have an autoimmune connective tissue disease and peripheral ulcerative keratitis die (mostly due to a heart attack) within 10 years of developing peripheral ulcerative keratitis. With treatment, about 8% of people die within 10 years. The eye problem itself is not the cause of death; it is the underlying autoimmune disorder's effect on the whole body.

Treatment of Peripheral Ulcerative Keratitis

  • Drugs that suppress the immune system

To treat peripheral ulcerative keratitis, doctors give drugs that suppress the immune system, such as methotrexate, cyclophosphamide, or rituximab taken by mouth or by vein (intravenously).

Doctors may also fill the ulcer with a special material (called tissue adhesive) and then cover the area with special contact lenses to control inflammation. Alternatively, doctors may surgically repair the cornea with a partial thickness corneal transplant Corneal Transplantation Corneal transplantation (keratoplasty) is a common and highly successful type of transplantation. A scarred, severely painful, perforated, misshapen, or cloudy cornea (the clear layer in front... read more .

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Eye Redness
Eye redness is a condition in which the part of the eye that is normally white appears reddish. This occurs when blood vessels on the surface of the eye widen (dilate), bringing extra blood to the eye. Which of the following is NOT a frequent cause of eye redness? 
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