Peripheral Ulcerative Keratitis

(Marginal Keratolysis; Peripheral Rheumatoid Ulceration)

ByMelvin I. Roat, MD, FACS, Sidney Kimmel Medical College at Thomas Jefferson University
Reviewed/Revised Aug 2022 | Modified Sep 2022

Peripheral ulcerative keratitis is a serious eye disorder that involves inflammation and ulceration of the cornea (the clear layer in front of the iris and pupil) that often occurs in people who have connective tissue disorders such as rheumatoid arthritis.

  • Symptoms include blurred vision, increased sensitivity to bright light, and a sensation of a foreign object in the eye.

  • Doctors diagnose peripheral ulcerative keratitis based on the appearance of the cornea in someone who has a connective tissue disorder.

  • Doctors treat the damaged cornea and give drugs to suppress the immune system.

An Inside Look at the Eye

Peripheral ulcerative keratitis is probably caused by an autoimmune reaction. In an autoimmune disorder, antibodies or cells produced by the body attack the body’s own tissues. Many autoimmune disorders affect connective tissue in a variety of organs. Connective tissue is the structural tissue that gives strength to joints, tendons, ligaments, and blood vessels. The connective tissue disorders that occur with peripheral ulcerative keratitis include rheumatoid arthritis, granulomatosis with polyangiitis, and relapsing polychondritis.

Peripheral ulcerative keratitis also may be caused by an infection.

Symptoms of Peripheral Ulcerative Keratitis

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.

Diagnosis of Peripheral Ulcerative Keratitis

  • A doctor's evaluation

  • Sometimes culture

The diagnosis of peripheral ulcerative keratitis is suspected when the doctor sees an affected cornea in a person who also has a severe and/or long-standing connective tissue disease.

If doctors suspect an infection, such as bacteria, fungi, or herpes simplex virus, is the cause of peripheral ulcerative keratitis, they scrape the ulcer and eyelid margins for a sample. The sample is then grown in a laboratory (cultured) to identify the organism.

Prognosis of Peripheral Ulcerative Keratitis

Without treatment, about 40% of people who have an autoimmune connective tissue disease and peripheral ulcerative keratitis die (mostly due to a heart attack) within 10 years of developing peripheral ulcerative keratitis. With treatment, about 8% of people die within 10 years. The eye problem itself is not the cause of death; it is the underlying autoimmune disorder's effect on the whole body.

Treatment of Peripheral Ulcerative Keratitis

  • Drugs that suppress the immune system

Doctors may also fill the ulcer with a special material (called tissue adhesive) and then cover the area with special contact lenses to control inflammation. Alternatively, doctors may surgically repair the cornea with a partial thickness corneal transplant.

Drugs Mentioned In This Article
Test your KnowledgeTake a Quiz!
Download the free Merck Manual App iOS ANDROID
Download the free Merck Manual App iOS ANDROID
Download the free Merck Manual App iOS ANDROID