PERIPHERAL ULCERATIVE KERATITIS IN THE COLLAGEN VASCULAR DISEASES

Peripheral ulcerative keratitis (PUK) is a crescent-shaped destructive lesion of the juxtalimbal corneal stroma associated with an epithelia l defect and stromal inflammatory cell infiltrate. PUK occurs in a var iety of ocular and systemic conditions (Table). In one study of noninf ectious PUK patients, approximately one-half of the cases occurred in patients with collagen vascular diseases, often as the disease's initi al manifestation [1]. Patients with collagen vascular disease-related PUK often require aggressive systemic treatment to stop the relentless progression of corneal destruction. In these patients, PUK is viewed as the heralding of a systemic and possibly life-threatening vasculiti s that requires systemic immunosuppressive therapy.