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Publication Exclusive: Amniotic membrane can be used to manage Mooren’s ulcer with descemetocele

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Mooren’s ulcer is a rare disorder that may require surgical intervention. Although Mooren’s ulcer can occur in both sexes at any age, it is usually seen in adult men who are otherwise healthy with often no detectable systemic illness. The exact etiology of Mooren’s ulcer remains unidentified to date, even though this condition was first described as early as 1849 by Bowman and further characterized by Mooren in 1863. Both cell-mediated and humoral immune mechanisms have been implicated in the possible pathogenic pathway, leading to peripheral corneal melt and corneal ulceration.Based partly on laterality and disease severity, Mooren’s ulcer is divided into three main types: limited type, malignant type and indolent type. A clinical pearl to keep in mind is that some of these patients may have intense ocular pain that is out of proportion to the ocular inflammatory findings. The symptomatic spectrum includes photophobia, redness, tearing and blurred vision, while signs include the typical peripheral corneal ulceration with a steep overhanging edge with limbal involvement. Adjacent conjunctival inflammation is usually evident. In addition to topical medical therapy, systemic immunosuppressive chemotherapy is usually indicated, and ocular surgical intervention becomes necessary when globe integrity is threatened by the ulceration or if there is a corneal perforation.

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