A 55-year-old patient with rheumatoid arthritis develops a peripheral corneal ulcer with an overhanging edge, thinning, and absent vascularisation progressing circumferentially. This condition is best described as:
- A Marginal keratitis secondary to staphylococcal hypersensitivity
- B Peripheral ulcerative keratitis (PUK) associated with systemic vasculitis/RA ✓
- C Mooren's ulcer (idiopathic peripheral ulcerative keratitis)
- D Terrien's marginal degeneration
Correct answer: B. Peripheral ulcerative keratitis (PUK) associated with systemic vasculitis/RA
Explanation
Peripheral ulcerative keratitis (PUK) associated with rheumatoid arthritis is a necrotising stromal ulceration at the corneal periphery driven by immune complex deposition and complement activation in the perilimbal vasculature. The presence of systemic autoimmune disease (RA, Wegener's, SLE) distinguishes PUK from Mooren's ulcer, which is idiopathic. Mooren's ulcer has a characteristic overhanging edge and progressive circumferential spread but is a diagnosis of exclusion. PUK in RA carries serious systemic implications including risk of vasculitic organ involvement.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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