Chronic inflammation of the peripheral cornea that slowly progresses centrally with corneal thinning and sometimes perforation. These noninfectious ulcerations touch the peripheral cornea and have been classified into 2 clinical types. Of the few studies of the course and therapy of mooren s ulcer, most were retrospective and involved relatively few patients. Some cases of corneal ulcer may also be idiopathic. In the 1960s there was a renewed interest in this condition with many reports coming from developing countries. Amniotic membrane transplantation ineffective as additional.
However, recent studies indicate that it is an autoimmune disease directed against a specific target molecule. One is a unilateral limited type that occurs in an older adult population. Nov 12, 2001 moorens ulcer is a condition that is diagnosed as much by what it is as by what it is not. Mooren ulcer definition of mooren ulcer by medical dictionary. Mooren s ulcer was first described by bowman in 1849 and later reported by mooren in 1867. Corneal ulcer is an inflammatory or, more seriously, infective condition of the cornea involving disruption of its epithelial layer with involvement of the corneal stroma. To shed more light on the ongoing question of optimal treatment of severe progressive moorens ulcer, we here report on a retrospective case series of patients treated with systemic immunosuppressive therapy. However, it was mooren who was the first to publish several cases of this condition in 1863 and was also the first to clearly describe this corneal condition and define it as a clinical entity 20.
Immunohistochemistry of terriens and moorens corneal. It may respond to oral immunosuppression, which is warranted if the severity threatens visual acuity because of impending corneal perforation. Wood and kaufman classified the disease into 2 groups according to the age of onset. Disease bioinformatics research of moorens ulcer has been linked to ulcer, corneal ulcer, corneal diseases, conjunctival diseases, inflammation. Its cause is unknown but it can or will lead to loss of vision if untreated. Three patients with severe, bilateral, progressive mooren s ulcers, unresponsive to medical and surgical therapy, were treated with cyclosporin a. Get a printable copy pdf file of the complete article 64k, or click on a page image below to browse page by page.
Moorens ulcer can have a similar appearance to these conditions. Moorens ulcer is a painful, progres sive thinning of the cornea that begins in the periphery and spreads circumferentially. It is a common condition in humans particularly in the tropics and the agrarian societies. Moorens ulcer mu is an eye condition that causes damage to and degeneration of the cornea.
Therefore many therapies of moorens ulcer are recommended in literature. The second patient responded to aggressive treatment with topical steroid therapy. Basic research increased succinate receptor gpr91 involved. Clinical characteristics and risk factors of recurrent moorens ulcer. Pain is almost always associated with the onset of moorens ulcer. Some cases run a chronic severe course and fail to respond to local and systemic therapy. It is also as called chronic serpiginous ulcer or ulcus serpens. Mooren s ulcer is a rare disorder of unknown etiology that is refractory to treatment.
Moorens ulcer a rare, superficial ulcer of the cornea of unknown origin. Mooren s ulcer is a chronic, painful peripheral ulcer of the cornea. This study evaluated the effect of microsurgery of lamellar keratoplasty lkp on moorens corneal ulcer. Moorens ulcer is a condition that is diagnosed as much by what it is as by what it is not. Moorens ulcer remains an uncommon disease in ibadan, southwest nigeria, and the clinical presentation is as recorded in other parts of the west african. Initial treatment of moorens ulceration consists of topical corticosteroids. Noncorticosteroid immunosuppressive agents, conjunctival.
Compression therapy has been proven beneficial for venous ulcer treatment and is the standard of care. Ulcer wounds should not be cleaned with skin cleansers or antiseptic agents e. Mooren s ulcer is a unilateral or bilateral corneal disorder that affects the peripheral circumference of the cornea, and has varying degrees of pain depending on the presentation. Mooren s ulcer was first described by bowman in 1849 2 and mckenzie in 1854 as chronic serpiginous ulcer of the cornea or ulcus roden 16. A 2, 7, 10, 2226, 45 leg elevation minimizes edema in patients with venous insufficiency and is. Moorens ulcer is a chronic, painful, peripheral ulcerative keratitis. Interestingly, those at the highest risk of contracting peptic ulcer disease are those. The ulcer bases were vascularized and very thin 10% of normal thickness. Ten eyes with progressing mooren s or similar ulcers were treated by excising a 3 to 4 mm ring of limbal conjunctiva adjacent to the ulcer. It is characterised by painful peripheral corneal ulceration of unknown aetiology.
It can affect not just the cornea but also the scleral tissue and can involve both eyes. While mooren s ulcer is by definition not associated with any systemic autoimmune disorder, it can be confused with corneal ulcers that are early warning signs of lifethreatening diseases, said c. Some patients with mooren ulcer have an autoantibody to calgranulin c. The patient had undergone an exenteratio bulbi of the left eye because of the perforation of a mooren s corneal ulcer. Jan 02, 2019 some cases of corneal ulcer may also be idiopathic. Hla and moorens ulceration craig j taylor, sheila i smith, catherine h morgan, susan f stephenson, tim key, m srinivasan, emmett cunningham jr, peter g watson abstract backgroundmoorens ulcer is a progressive intractable destructive peripheral ulceration of the cornea, probably of autoimmune aetiology.
A perusal of the literature leads one to the conclusion that several cases have been recorded as moorens ulcer which, strictly speaking, did. Recent evidence supports the notion that autoimmune mechanisms are. Mooren s ulcer continues to be a baf fling disease. The patient had undergone an exenteratio bulbi of the left eye because of the perforation of a moorens corneal ulcer. It is an idiopathic, painful relentlessly progressive,chronic ulcerative keratitis begins. Moorens ulcer was first described by bowman in 1849 and later reported by mooren in 1867. To report an apparently beneficial effect of topical interferon alfa 2a ifn. Mooren ulcer synonyms, mooren ulcer pronunciation, mooren ulcer translation, english dictionary definition of mooren ulcer. Jan 22, 2018 moorens ulcer mu is an eye condition that causes damage to and degeneration of the cornea.
Approximately 500,000 new cases are reported each year, with 5 million people affected in the united states alone. All three responded rapidly to the drug and there has been no recurrence of the moorens ulcers since average followup 14 months. The study of moorens ulcer has been mentioned in research publications which can be found using our bioinformatics tool below. Moorens ulcer can only be diagnosed in the absence of an infectious or systemic cause and must be differentiated from other corneal abnormalities, such as terriens degeneration. Mooren s ulcer mu is an eye condition that causes damage to and degeneration of the cornea. Management of perforated moorens ulcer with a rotational. Mooren s ulcer in september 1974, a previously healthy 79yearold woman presented with a fourmonth history of bilateral, painful, peripheral corneal ulcerations. It starts near the limbus as an overhanging advancing edge that in severe cases spreads over the entire cornea and may even invade the sclera.
From the department of ophthalmology, university of pittsburgh school of medicine. Introduction peptic ulcer disease represents a serious medical problem. The incidence, clinical characteristics, and severity of moorens ulcer widely vary geographically and. Clinical characteristics and risk factors of recurrent mooren. Mooren s ulcer can only be diagnosed in the absence of an infectious or systemic cause and must be differentiated from other corneal abnormalities, such as terriens degeneration. To describe the management of perforated moorens ulcer using scleral rotational autograft. Moorens ulcer is a chronic, painful peripheral ulcer of the cornea. Moorens ulcer is a rare disorder of unknown etiology that is refractory to treatment. Severe pain is common in patients with moorens ulcer and the eyes may be intensely reddened, inflamed and photophobic, with tearing. If corticosteroids do not control the inflammation, limbal conjunctival. These data may help explain why terriens marginal degeneration runs a more benign course than does moorens ulcer and provides a rationale forthe use of immunosuppressivedrugs to treat moorens ulcer. Ten eyes with progressing moorens or similar ulcers were treated by excising a 3 to 4 mm ring of limbal conjunctiva adjacent to the ulcer. It is an idiopathic, painful relentlessly progressive,chronic ulcerative keratitis begins peripherally and progresses circumferentially and centrally. Cases presenting late with perforation and uveal prolapse are a serious challenge to management, particularly in a setting where corneal grafting is not routinely practiced.
Mooren ulcer article about mooren ulcer by the free dictionary. Moorens ulcer, also referred to as mooren ulcer, is a rare, painful, inflammatory condition affecting one or both eyes that results in the destruction of corneal tissue. Treatment of mu is often challenging, but typically includes local andor systemic corticosteroids. Full text full text is available as a scanned copy of the original print version. Mooren ulcer medigoo health medical tests and free health. The cornea is the outside layer of your eye that covers the front of your eye.
Moorens ulcer mu is an inflammatory peripheral ulcerative keratopathy that occurs most commonly in the developing world. First described in detail as a clinical entity by mooren in 1867. Background mooren ulcer has been considered as an idiopathic autoimmune keratitis. We report a case of a 74yearold man with a history of bilateral and malignant moorens ulcer. The disease generally begins with intense limbal inflammation and swelling in episclera and conjunctiva. Pain is almost always associated with the onset of mooren s ulcer. Purpose management of severe and refractory moorens ulcers is challenging as it encompasses tectonic surgical treatment and aggressive. Moorens ulcer is a rare degenerative superficial ulcer which occurs at corneal margin and its etiology is unknown. These data may help explain why terriens marginal degeneration runs a more benign course than does mooren s ulcer and provides a rationale forthe use of immunosuppressivedrugs to treat mooren s ulcer. Seven of these eyes have remained healed, while one eye has had repeated ulcers which healed when retreated with conjunctival exicision. So, a thorough history and evaluation of the appearance and characteristics of the ulcer must be crossreferenced with a list of differentials to come up with a definitive diagnosis. One is a milder, unilateral, less progressive form of the disease generally seen in elderly patients that responds well to therapy. Mooren ulcer is too rare for therapeutic options to be studied in randomized clinical trials.
Moorens ulcer is a severe ulcerative inflammation of the cornea. A perusal of the literature leads one to the conclusion that several cases have been recorded as mooren s ulcer which, strictly speaking, did not belong in that classification. Conclusion moorens ulcer is often recalcitrant and aggressive disorder a multimodality management is required to bring the disease under control immunosuppression is paramount to disease control a systematic step ladder approach offers good results 32. However, it has been in some cases suggested to be associated with hepatitis c, although the evidence is very vague. Texas prior authorization program clinical criteria drugdrug. Dec 17, 20 moorens ulcer is a severe ulcerative inflammation of the cornea. Texas prior authorization program clinical criteria hp acthar.
While moorens ulcer is by definition not associated with any systemic autoimmune disorder, it can be confused with corneal ulcers that are early warning signs of lifethreatening diseases, said c. Amniotic membrane transplantation for moorens ulcer. The ulcerations progressed over the next nine months to involve the entire corneal periphery with overhanging edges fig 1. Peripheral curvilinear infiltrates in superficial cornea often where the lids cross the corneal periphery associated with loss of corneal epithelium. Oct 10, 20 conclusion moorens ulcer is often recalcitrant and aggressive disorder a multimodality management is required to bring the disease under control immunosuppression is paramount to disease control a systematic step ladder approach offers good results 32. Three patients with severe, bilateral, progressive moorens ulcers, unresponsive to medical and surgical therapy, were treated with cyclosporin a. Mooren ulcer definition of mooren ulcer by the free dictionary. The surgical effect, postoperative astigmatism, postoperative vision, postoperative ulcer recurrence, and surgical complications of 2 groups of consecutive moorens ulcer inpatients treated respectively by non.
All three responded rapidly to the drug and there has been no recurrence of the mooren s ulcers since average followup 14 months. Severe pain is common in patients with mooren s ulcer and the eyes may be intensely reddened, inflamed and photophobic, with tearing. Moorens ulcer is an idiopathic unknown origin noninfectious ulceration the process or fact of being eroded away, as by an ulcer of the peripheral cornea that has been classified into 2 clinical types. Moorens ulcer can only be diagnosed in the absence of an infectious or. Its cause is unknown but it can or will lead to loss of vision. Of the few studies of the course and therapy of moorens ulcer, most were retrospective and involved relatively few patients. Mooren s ulcer is a rapidly progressive, painful, ulcerative keratitis which initially affects the peripheral cornea and may spread circumferentially and then centrally. Get a printable copy pdf file of the complete article 401k, or click on a page image below to browse page by page. The authors present a case of unilateral moorens ulcer in a young.
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