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Peripheral Ulcerative Keratitis

(Marginal Keratolysis; Peripheral Rheumatoid Ulceration)

By Melvin I. Roat, MD, FACS

Peripheral ulcerative keratitis is inflammation and ulceration of the cornea that often occurs in people who have connective tissue disorders such as rheumatoid arthritis.

Peripheral ulcerative keratitis is probably caused by an autoimmune reaction (see page Autoimmune Disorders). People develop blurred vision, increased sensitivity to bright light, and a sensation of a foreign object trapped in the eye. The ulcer is located in the margin of the cornea and is usually oval in shape.

Of the people who have rheumatoid arthritis and peripheral ulcerative keratitis, about 40% die (mostly due to a heart attack) within 10 years of developing peripheral ulcerative keratitis unless they are treated. Rheumatoid arthritis is what causes peripheral ulcerative keratitis and death due to a heart attack. Treatment with drugs that suppress the immune system, such as cyclophosphamide taken by mouth or by vein (intravenously), reduces the death rate to a more normal level of about 8% in 10 years.

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