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.
Dietary copper can be found in whole grain cereals, legumes, oysters, organ meats (particularly liver), cherries, dark chocolate, fruits, leafy green vegetables, nuts, poultry, prunes, and soybean products like tofu.Copper deficiency can have many hematological consequences, such as myelodysplasia, anemia, low white blood cell count, and low count of neutrophils (a type of white blood cell that is often called "the first line of defense" of the immune system). Copper deficiency has long been known as a cause of myelodysplasia (when a blood profile has indicators of possible future leukemia development), but it was not until 2001 that copper deficiency was associated with neurological manifestations like sensory ataxia (irregular coordination due to proprioceptive loss), spasticity, muscle weakness, and more rarely visual loss due to damage in the peripheral nerves, myelopathy (disease of the spinal cord), and rarely optic neuropathy. Signs and symptoms
Blood symptoms
The characteristic hematological (blood) effects of copper deficiency are anemia (which may be microcytic, normocytic or macrocytic) and neutropenia. Thrombocytopenia (low blood platelets) is unusual.The peripheral blood and bone marrow aspirate findings in copper deficiency can mimic myelodysplastic syndrome. Bone marrow aspirate in both conditions may show dysplasia of blood cell precursors and the presence of ring sideroblasts (erythroblasts containing multiple iron granules around the nucleus).