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.
A branchial cleft cyst is a cyst as a swelling in the upper part of neck anterior to sternocleidomastoid. It can, but does not necessarily, have an opening to the skin surface, called a fistula. The cause is usually a developmental abnormality arising in the early prenatal period, typically failure of obliteration of the second, third, and fourth branchial cleft, i.e. failure of fusion of the second branchial arches and epicardial ridge in lower part of the neck. Branchial cleft cysts account for almost 20% of neck masses in children. Less commonly, the cysts can develop from the first, third, or fourth clefts, and their location and the location of associated fistulas differs accordingly. Symptoms and signs
Most branchial cleft cysts present in late childhood or early adulthood as a solitary, painless mass, which went previously unnoticed, that has now become infected (typically after an upper respiratory tract infection). Fistulas, if present, are asymptomatic until infection arises. Pathophysiology
Branchial cleft cysts are remnants of embryonic development and result from a failure of obliteration of one of the branchial clefts, which are homologous to the structures in fish that develop into gills. Pathology
The cyst wall is composed of squamous epithelium (90%), columnar cells with or without cilia, or a mixture of both, with lymphoid infiltrate, often with prominent germinal centers and few subcapsular lymph sinuses. The cyst is typically surrounded by lymphoid tissue that has attenuated or absent overlying epithelium due to inflammatory changes. The cyst may or may not contain granular and keratinaceous cellular debris.