With limited diffusion, there is a higher concentration of IgM, factor C1 of the complement cascade, and Langerhans cells. Any kind of inflammatory stimulus present in the peripheral cornea results in recruitment of neutrophil and activation of both classical and alternative pathways of immune response, namely the humoral and cell-mediated autoimmune responses. These responses will lead to the formation of antigen-specific antibodies to combat foreign antigens. However, antigen-antibody complexes formed may deposit in the vascular endothelium and activate complements leading to severe local inflammation. Under this circumstance, inflammatory cells, such as macrophages and neutrophils, enter the peripheral cornea. These inflammatory cells release enzymes protease and collagenases, causing potential disruption of the corneal stroma. The additional release of cytokines, for example, interleukin-1, from these cells further accelerates the process of stromal destruction. Moorens ulcer and relevant classification
Moorens ulcer is a common form of PUK. One classification of Moorens ulcer, based on the clinical presentation, includes bilateral indolent moorens ulcer, bilateral aggressive moorens ulcer and unilateral moorens ulcer. Unilateral moorens ulcer, meaning ulcer of one eye, mainly affects elderly above 60 years old. Rapid onset with redness and severe pain of the affected eye and either slow or extremely quick progression are some typical characteristics of unilateral moorens ulcer. Bilateral aggressive moorens ulcer is prevalent in Indian between age 14 to 40. The common presentation includes the appearance of lesions in one eye, followed by the development of lesions in another eye. Finally, bilateral indolent moorens ulcer is common in patients of at least 50-year-old.
Finally, a chest X-ray helps distinguish whether there are complications, such as pulmonary diseases, due to systemic conditions associated with PUK.One of the common causes of PUK is ocular infections by microorganisms such as bacteria, viruses, and fungi. To detect the causative microorganism, doctors usually collect samples before the commencement of therapy and send them to laboratories. Laboratory personnel then perform smear examination, inoculate the samples on culture media, and perform serological testing. Serological testing is an antibody test providing information on PUK etiology. The diagnosis of PUK due to systemic conditions requires a combination of serological and hematological testing, together with imaging techniques such as radiography and CT scanning. Treatments
Various PUK therapies are of different objectives, for example, inflammation control, halting of disease progression, stroma repairment, avoidance of secondary complications, and vision restoration. A thorough understanding of PUK and different therapies is important. Medical and surgical treatments are two major approaches to manage PUK. Medical therapy
As for medical therapy, there are several types of drugs available for PUK. Topical corticosteroids usually serve as therapy for milder unilateral cases of RA-associated PUK. Systemic corticosteroids in the form of an oral dose are the acute management of more severe cases. However, there are side effects with prolonged usage of oral corticosteroids. Immunosuppressive agents, such as azathioprine, cyclophosphamide, and methotrexate, have demonstrated efficacy in treating inflammatory eye diseases, including PUK. The combined therapy of systemic corticosteroids up to 100 mg/day and immunosuppressive agents are used for severe cases of PUK.