Abstract
Although the diagnosis may be difficult when a patient first presents with Mooren's ulceration, the clinical appearances are characteristic and should not be confused with other conditions which cause corneal ulceration. Based on the clinical presentation and the low-dose anterior segment fluorescein angiographic findings, there seem to be three distinct varieties of Mooren's ulceration: (1) Unilateral Mooren's ulceration (UM), characterised by an excessively painful progressive corneal ulceration in one eye in elderly patients, associated with non-perfusion of the superficial vascular plexus of the anterior segment. (2) Bilateral aggressive Mooren's ulceration (BAM), which occurs in young patients, progresses circumfer-entially and, only later, centrally in the cornea. Angiography shows vascular leakage and new vessel formation which extends into the base of the ulcer. (3) Bilateral indolent Mooren's ulceration (BIM), which usually occurs in middle-aged patients presenting with progressive peripheral corneal guttering in both eyes, with little inflammatory response. There is no change from the normal vascular architecture on angiography except an extension of new vessels into the ulcer. The management differs in each of these varieties.
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Robin JB, Scharzlin DJ, Verity SM, et al. Peripheral corneal disorders. Surv Ophthalmol 1986;31:1–36.
Mooren A . Ophthalmiatrische Beobachtungen. Berlin: Hirschwald, 1867:107.
Mooren A . Ophthalmiatrische Mittheilungen aus den Jahre 1873.
Foster CS . Systemic immunosuppressive therapy for progressive bilateral Mooren's ulcer. Ophthalmology 1985;92:1436–9.
Nettleship E . Chronic serpiginous ulcer of the cornea (Mooren's ulcer). Trans Ophthalmol Soc UK 1902;22:103–43.
Kuriakose E . Mooren's ulcer. Am J Ophthalmol 1963;55:1064–9.
Wood TO, Kaufman HE . Mooren's ulcer. Am J Ophthalmol 1971;71:417.
Watson PG, Bovey E . Anteror segment fluorescein angiography in the diagnosis of scleral inflammation. Ophthalmology 1985;92:1–11.
Meyer PA, Watson PG . Low dosage fluorescein angiography of the conjunctiva and episclera. Br J Ophthalmol 1987;71:2–10.
Stilma JS . Conjunctival incision of lamellar scleral autograft in 38 Mooren's ulcers from Sierra Leone. Br J Ophthalmol 1983;67:475–8.
Keitzman B . Mooren's ulcer in Nigeria. Am J Ophthalmol 1968;65:679.
Watson PG . Vascular changes in peripheral corneal destructive disease. Eye 1990;4:65–73.
Watson PG . Pathogenesis of corneal destructive diseases. CIBA Symp Proc 1995;4:60–77.
Charles SJ, Meyer PAR, Watson PG . Diagnosis and management of systemic Wegener's granulomatosis presenting with ocular disease. Br J Ophthalmol 1991;75:201–7.
Linn JG Jr. Chronic serpiginous ulcer of the cornea (Mooren's ulcer): etiologic and therapeutic considerations. Am J Ophthalmol 1949;32:691.
Schaap OL, Feltkamp TEW, Breebaart AC . Circulatory antibodies to corneal tissue in a patient suffering from Mooren's ulcer. Clin Exp Immunol 1969;5:365–70.
Mondino BJ . Inflammatory diseases of the peripheral cornea. Ophthalmology 1988;95:463–72.
Gottsch JD, Liu SH, Minkovitz JB, Goodman DF, Srinivasan M, Start WJ . Autoimmunity to a cornea-associated stromal antigen in patients with Mooren's ulcer. Invest Ophthalmol Vis Sci 1995;36:1541–7.
Kruit PJ, Van der Graaf R, Broersma L, Kijlstra A . Auto-immunity against corneal antigens. I. Isolation of a soluble 54 kD corneal epithelium antigen. Curr Eye Res 1986;5:313–20.
Jing-cheng Z, Xiu-ying J . Immunological analysis, and treatment of Mooren's ulcer with cyclosporin A applied topically. Cornea 1993;12:481–8.
Murray PI, Pahi AH . Pathogenesis of Mooren's ulcer: some new concepts. Br J Ophthalmol 1984;68:182–7.
Van der Gaag R, Abdillah H, Stilma JS, Vetter JCM . Circulating antibodies against corneal epithelium and hookworm in patients with Mooren's ulcer from Sierra Leone. Br J Ophthalmol 1983;67:623–8.
Riley GP, Harrall RL, Watson PG, Cawston TE, Hazleman BL . Collagenase (MMP-1) and TIMP-1 in destructive corneal disease associated with rheumatoid arthritis. Eye 1995;9:703–18.
Mondino BJ, Brown SI, Robin BS . Cellular immunity in Mooren's ulcer. Am J Ophthalmol 1978;85:788–91.
Brown SI, Mondino BJ, Robin BS . Autoimmune phenomena in Mooren's ulcer. Am J Ophthalmol 1976;82:835–40.
Young RD, Watson PG . Light and electron microscopy of corneal melting syndrome (Mooren's ulcer). Br J Ophthalmol 1982;66:341–56.
Brown SI . What is Mooren's ulcer? Trans Ophthalmol Soc UK 1978;98:390–92.
Eifemann RA, Hyndrik RA, Hensley GT . Limbal immunopathology of Mooren's ulcer. Ann Ophthalmol 1978;10:1203–6.
Foster CS, Kenyon KR, Greiner J, Greineder DK, Frieland B, Allansmith MR . The immunopathology of Mooren's ulcer. Am J Ophthalmol 1979;88:149–59.
Sie Boen Liam, Li Shao Chen . The possibility of a virus aetiology of rodent corneal ulcer (Mooren's). Ophthal-mologica 1960;140:311–22.
Wilson SE, Lee WM, Murakami C, Weng J, Moninger GA . Mooren-type hepatitis C virus associated corneal ulceration. Ophthalmology 1994;101:736–45.
Hill JC, Potter P . Treatment of Mooren's ulcer with cyclosporin A: a report of three cases. Br J Ophthalmol 1987;71:11–5.
Wakefield D, Robinson LP . Cyclosporin therapy in Mooren's ulcer. Br J Ophthalmol 1987;71:415–7.
Meyer PAR, Watson PG, Frank SW, Dubord R . Pulsed immunosuppressive therapy in the treatment of immunologically induced corneal and scleral disease. Eye 1987;1:487–95.
Agrawal V, Kumar A, Sangwan V, Rao G . Cyano-acrylate adhesive with conjunctival resection and superficial keratectomy in Mooren's ulcer. Indian J Ophthalmol 1996;44:23–7.
Tabarra KF . Mooren's ulcer. Int Ophthalmol Clin 1986;26:91–8.
Gifford S . Delimiting keratotomy. Am J Ophthalmol 1922;5:697.
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Watson, P. Management of Mooren's ulceration. Eye 11, 349–356 (1997). https://doi.org/10.1038/eye.1997.74
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DOI: https://doi.org/10.1038/eye.1997.74
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