Mooren’s Corneal Ulcer

Image of Mooren's corneal ulcer, which can be treated with amniotic membrane.

Mooren’s corneal ulcer (MU) is a painful, recurrent ulcerative keratitis (inflammation of the edges of the cornea) that begins along the edges of the cornea and progresses. There is no damage to the sclera or the whites of the eyes. Mooren’s ulcer can be benign and cause little pain or discomfort. Rarely, benign MU is bilateral. More unusually, MU can be malignant, which is more painful and can, in a short time, lead to severe damage to the cornea. In this case, both eyes are usually affected.
Mooren’s ulcer is noticeable with inflammation of the limbus, the boundaries of the cornea. An area near the limbus appears to have gray swellings. It proceeds over four to twelve months. The swellings furrow. The bed of the furrow develops vessels into the edges of the ulcers. They are crescent-shaped. The furrows can also overwhelm the corneal stroma, the thickest layer of the cornea, replacing it with a thin fibrovascular membrane. The damage does not usually extend to the endothelium and epithelium. It is likely due to an eye-specific immune issue, but the cause is unknown. MU can lead to corneal thinning and perforation, which a surgeon must treat. Patients with Mooren’s ulcer should have a doctor evaluate them for a generalized autoimmune disorder. A doctor will only diagnose Mooren’s in the absence of evidence that an underlying autoimmune disorder is directly causing the problem.
The exact cause of MU is unclear. Many MU symptoms are similar to immune system eye disorders. This may mean that MU is caused by an immune response due to autoimmune disease response to eye injury or infection. There is a possible link between MU and hepatitis C. Risk factors for MU include corneal surgery, previous trauma, and infection.
Just as with pterygium and symblepharon, epending on the aggression of the Mooren’s ulcer, amniotic membrane transplant might be a potential treatment option. In one case that did not resolve with topical steroids and cyclosporine A eye drops nor with a peritomy, AMT was performed and supplemented with autologous serum eye drops four times per day. The symptoms of pain, redness, watering, and decreased vision improved in a week. The ulcer ceased progressing, and vascularization decreased. Nine months later, the ulcer had healed.
Benign MU often doesn’t need to be treated if it doesn’t cause pain or doesn’t have any risk of complications.
If treatment is needed, the doctor may treat both benign and malignant MU using one or more of the following:

  • surgical removal of tissues surrounding the ulcer
  • topical treatments
  • antibiotics to prevent infections
  • interferon a2b for hepatitis C infections, sometimes combined with antivirals
  • cryotherapy, freezing and removing ulcer tissue
  • tissue adhesion

Conclusion
To summarize: The symptoms of MU can include:

  • pain in the eye
  • thinning or tearing of the corneal tissue
  • redness
  • unusual sensitivity to light (photophobia)
  • inflammation of the eye’s middle layer (iritis or uveitis)
    If malignant Mooren’s is not treated, complications can include:
  • conjunctivitis
  • inflammation and pus
  • blurriness in the eye lens (cataracts)
  • punctures in the cornea (perforation)
  • optic nerve damage (glaucoma)
  • loss of vision or blindness

Therefore, you should medical advice to determine whether your condition is benign or malignant.