A 60-year-old man presents with progressive, painful bilateral peripheral corneal ulcers with an overhanging central edge and undermined epithelium, advancing circumferentially. There is no associated scleritis. Which clinical feature most reliably distinguishes Mooren's ulcer from other causes of peripheral ulcerative keratitis?
- A Overhanging central edge with undermined epithelium ✓
- B Bilateral involvement
- C Progressive circumferential spread
- D Severe pain out of proportion to signs
Correct answer: A. Overhanging central edge with undermined epithelium
Explanation
The overhanging central edge with undermined epithelium is the pathognomonic feature of Mooren's ulcer, distinguishing it from other peripheral ulcerative keratitis causes. Bilateral involvement and circumferential spread can occur in Mooren's but are not pathognomonic. Severe pain out of proportion to signs is characteristic of Acanthamoeba keratitis. The overhanging edge reflects the autoimmmune-mediated stromal lysis unique to Mooren's ulcer.
Reference: Kanski's Clinical Ophthalmology, 9th ed.
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