Mooren ulcer

Mooren ulcer is a rare, chronic, painful, progressive ulcerative condition of the cornea (the clear front surface of the eye). It is characterized by peripheral corneal ulceration that typically begins at the limbus (the border between the cornea and the white of the eye) and progresses circumferentially and then centrally, potentially leading to severe vision loss or even perforation of the cornea. The ulcer is idiopathic but is believed to involve an autoimmune mechanism in which the body's immune system attacks corneal stromal proteins. Mooren ulcer is distinguished from other causes of peripheral ulcerative keratitis by the absence of associated systemic autoimmune or infectious disease. Two clinical subtypes are generally recognized. The first is a unilateral, limited form that tends to occur in older adults and responds relatively well to treatment. The second is a bilateral, aggressive form that is more common in younger patients, particularly in certain populations in sub-Saharan Africa and the Indian subcontinent, and is more resistant to therapy. Symptoms include severe eye pain, tearing, redness, photophobia (light sensitivity), and progressive visual impairment. The ulceration can lead to corneal thinning, descemetocele formation, and perforation if untreated. Treatment of Mooren ulcer is challenging and often requires a stepwise approach. Initial management may include topical corticosteroids and cyclosporine to suppress local inflammation. Surgical interventions such as conjunctival resection or excision of the limbal conjunctiva adjacent to the ulcer can be effective, particularly in the limited form. In refractory or aggressive cases, systemic immunosuppressive agents such as methotrexate, cyclophosphamide, or mycophenolate mofetil may be necessary. Corneal grafting (keratoplasty) may be required for perforation or severe thinning, though recurrence in the graft is possible. Despite treatment, the prognosis for the aggressive bilateral form remains guarded.

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