It may lead to an increased risk of a sensitization to corneal antigens and an autoimmune reaction against antigens expressed in corneal tissues. HLA association
Like most autoimmune diseases, Moorens ulcer is thought to be associated with specific HLA haplotypes. In some studies, HLA-DR17 and HLA-DQ2 have been found in increased frequencies in affected patients compared to healthy controls. These results propose a possible association between HLA and Moorens ulcer. Pathology
The precise pathophysiological mechanism of Moorens ulcer remains unclear, but most data suggest that both cell-mediated immunity and humoral immunity are involved in the pathogenesis of the disease.Reduces numbers of suppressor T cells have been found in peripheral blood from patients with Moorens ulcer. This deficit in systematic immunoregulatory mechanism may lead to loss of a control over autoreactive T and B cells and contributes to disease pathogenesis.Immunohistochemical studies in patients suffered from Moorens ulcer showed massive infiltration of multiple types of inflammatory cells in the conjunctival tissue. The cell types in the inflammatory lesion includes CD4+ and CD8+ T-lymphocytes, B-lymphocytes, macrophages, a small amount of neutrophils was also observed in the conjunctiva from patients with Moorens ulcer.In addition, circulating IgG antibodies with specificity for corneal and conjunctival antigens have been isolated from patients with Mooren’s ulcer. Gottsch and colleagues have suggested that calgranulin C, a protein expressed in the corneal stroma, may be a possible main target for autoimmune response causing Mooren’s ulcer.Also, significantly increased expression levels of adhesion and co-stimulatory molecules have been found in ocular tissues affected by Moorens ulcer compared to healthy eyes.
Moorens ulcer is a rare idiopathic ocular disorder that may lead to blindness due to progressive destruction of the peripheral cornea. Although the etiology of Moorens ulcer is poorly understood, recent evidence suggests that the pathogenesis of this disease appears to be the result of an autoimmune process directed against molecules expressed in the corneal stroma.Moorens ulcer is also defined as a special and the most common type of peripheral ulcerative keratitis (PUK). Signs and symptoms
Symptoms of Moorens ulcer can include:
Pain in the affected eye(s)
Redness of the affected eye(s)
Progressive ulceration of the cornea
Blurred vision
Photophobia
TearingSome epidemiological studies have noted that men tend to be affected more than women. Classification
The most commonly used classification was proposed by Watson in 1997. He divided the disease into three types based on the clinical picture:
Unilateral Moorens ulceration is characterized by extremely painful progressive ulceration of the cornea in one eye. This form is more common in elderly patients. Bilateral aggressive Moorens ulceration which is observed more often in young patients and progresses along the entire circumference, then captures the central area of the cornea. Bilateral indolent Moorens ulceration (BIM) usually occurs in middle-aged patients and manifested by a progressive peripheral corneal guttering in both eyes. Risk factors
Several risk factors affecting the development of Moorens ulcer have been suggested. Corneal trauma
Previous ocular trauma or infection can cause disruption of the corneal integrity resulting in the expression of tissue-specific antigens that are normally hidden from the immune system.