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I like grouping autoimmune disorders together by the different parts of the body they affect. Today I want to focus on the eyes. Having autoimmune disorders that affect my eyes, I’m always interested in this topic. Trying to my eyes healthy, irritation free and not red is a daily challenge.
Today I am focusing on Mooren’s Ulcer, Ocular Cicatricial Pemphigoid (OCP) and Optic Neuritis.
Mooren’s ulcer (MU) is an eye condition that causes damage to and degeneration of the cornea. The cornea is the outside layer of your eye that covers the front of your eye.
MU is a type of keratitis. Keratitis is inflammation of the edges of the cornea. MU is different from other types of corneal ulcers because it happens along the edge of the cornea where it meets the sclera. The sclera is the white of your eye. Because of this, it’s known as a type of peripheral ulcerative keratitis (PUK).
MU is extremely rare. There’s not much information about how common it is in the United States. Cases of MU are recorded more frequently in China, India, and Africa.
Two Types of Mooren’s Ulcer
These two classifications are based on laterality (one or both eyes) and age of onset:
- Limited (benign) type. This type of MU doesn’t cause much pain or discomfort. It usually only happens in one eye (unilaterally). Only 25 percent of cases of the benign type happen in both eyes (bilaterally). It’s more common if you’re older. Benign MU can cause discomfort but is harmless and doesn’t need to be treated right away. You can often go for years without treating MU and not experience any complications.
- Atypical (malignant) type. This type is more painful and can quickly cause your cornea to break down if it’s not treated. It usually happens in both eyes. About 75 percent of cases of the malignant type happen in both eyes. Malignant MU can be painful and quickly cause irreversible damage to your cornea, sometimes resulting in vision loss. In many cases, this type of MU can be treated and you won’t permanently lose any vision. Prompt treatment is important to avoid long-term complications.
More recent classifications group Mooren’s ulcer into three types based upon their clinical presentation:
- Unilateral Mooren’s ulceration (UM). This is a painful and progressive corneal ulcer typically seen in elderly patients.
- Bilateral aggressive Mooren’s ulceration (BAM). This type occurs in young patients. The ulcer progresses circumferentially then centrally in the cornea.
- Bilateral indolent Mooren’s ulceration (BIM). This type usually occurs in middle-aged patients. It presents with progressive peripheral corneal ulceration in both eyes.
Symptoms of Mooren’s Ulcer
The symptoms of MU can include:
- intense pain in the affected eye(s)
- thinning or tearing of the corneal tissue
- redness in the affected eye(s)
- unusual sensitivity to light (photophobia)
- inflammation of the uvea, the eye’s middle layer (iritis or uveitis)
MU is only diagnosed when other underlying inflammatory conditions, such as rheumatoid arthritis, can be ruled out as a cause of corneal damage.
Other, more common corneal conditions, such as Terrien’s degeneration, also need to be ruled out before your doctor can give you a confident diagnosis. To rule out Terrien’s degeneration, your doctor will check if the ulcer has spread to the middle of your cornea. If it hasn’t, they can rule out this condition.
Unlike other corneal conditions, MU doesn’t happen along with inflammation of the whites of your eyes (scleritis), so your doctor will check for this symptom, too.
Treatment of Mooren’s Ulcer
Benign MU often doesn’t need to be treated if it doesn’t cause pain or doesn’t have any risk of complications.
If treatment is needed, both benign and malignant MU may be treated using one or more of the following:
- topical treatments to keep tissue from degenerating
- antibiotics, such as moxifloxacin (Vigamox), to prevent infections
- interferon a2b for hepatitis C infections, sometimes combined with the antiviral medication ribavirin (Rebetron)
- resection, or surgical removal of tissues surrounding the ulcer
- cryotherapy, which involves freezing and surgically removing ulcer tissue
- tissue adhesion, which involves placing materials near the ulcer to stop it from spreading
My next blog post I will discuss Optic Neuritis.
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Covering everything from high-tech laser treatments to centuries-old Asian remedies, Dr. Abel’s authoritative, reliable information will help you and your doctor become full partners in saving your eyes and your overall good health.
When all is well with our eyes, most of us take them for granted. But when our vision is blurred or our eyes are itchy and watery, it’s hard to concentrate on anything but our eyes. In The Eye Book, three eye care specialists present a comprehensive reference to help readers care for their eyes and protect their vision, with special attention to changes and diseases that occur in the adult years.