It usually progresses slowly and causes little or no pain.Other classification methods also exist. The first one is classifying Moorens ulcers based on clinical presentation and prognosis into two categories. The first type is usually presented unilaterally, accompanied by symptoms ranging from mild to moderate. Therefore, it has a more effective response to treatment. In contrast, type II appears in a bilateral manner, with severe symptoms and poor outcome of treatment. The second classification is based on severity. Grade I refers to corneal thinning, grade II describes impending corneal perforation, and grade III is corneal perforation with a diameter greater than 2mm. Diagnosis
There are many investigative modalities available for diagnosing PUK, including history review and physical examination. A thorough history of ocular infections, contact lens usage, other medication, or surgery is necessary to identify possible presence of associated diseases. An ophthalmic examination helps identify whether it is due to local pathogenesis. Physical examinations allow more understanding of the underlying systemic process.A standard testing procedure includes hematological investigations, immunological testing, followed by chest X-ray. Hematological investigations are blood tests estimating hemoglobin, platelet counts, total white blood cell counts, erythrocyte sedimentation rate and viscosity. Other common body checks include urinalysis and liver and renal function tests. The selection of immunological testing for various markers is based on numerous additional medical examinations and clinical history of the patient. Possible markers are antinuclear antibodies, anti-rheumatoid antibodies, and antibodies to cyclic citrullinated peptides.
The formation of an oval-shaped ulcer at the margin of the cornea is also a sign.Symptoms of PUK include pain, redness, tearing, increased sensitivity to bright light, impaired or blurred vision, and the feeling of foreign objects trapped in the eyes. Association
There are several associations of PUK to ocular and systemic diseases. Rheumatoid arthritis (RA),  Wegners granulomatosis (WG), and Polyarteritis Nodosa (PAN) are the most common systemic conditions. Rheumatoid arthritis: Approximately 50% of PUK are related to collagen vascular diseases, in which RA is the most common category. Around 34-42% of PUK patients have RA. Wegners granulomatosis: WG is a rare autoimmune disease associated with PUK. It causes vasculitis of the lower and upper respiratory tracts, and it also affects multiple organs, including eyes. Without timely initiation of systemic therapy, WG patients will develop conjunctival and scleral inflammations. The inflammation will eventually cause corneal thinning and worsen PUK. Polyarteritis Nodosa: PAN is another autoimmune disease in which the bodys immune system attacks small and medium-sized arteries of its own by mistake. PUK is one of the predominant ocular inflammatory manifestations of PAN. Causes
There are three major causes for PUK. One possible cause is injury due to any kind of scratches by sharp or hard objects on the surface of the cornea. The scratched area forms an opening in the cornea, allowing microorganisms to access the cornea and lead to infection.