Which physical findings are characteristic of peripheral ulcerative keratitis (PUK)?

Updated: Jun 11, 2019
  • Author: Ellen N Yu-Keh, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Answer

Examination should be complete and include an overview of the head (including the nose, mouth, and external ear), trunk, joints, and extremities. [4] Skin lesions should also be noted.

A complete ophthalmic examination should be performed with special emphasis on the conjunctiva, sclera, and cornea. Anterior chamber, vitreous, and fundus examinations are also important.

Patients with PUK typically present with decreased visual acuity (secondary to induced irregular astigmatism), tearing, and eye irritation with or without pain of variable duration. [5]

Bilateral disease may be present in 21% of patients. [13]

Slit lamp examination reveals a crescent-shaped destructive lesion of the juxtalimbal corneal stroma associated with an epithelial defect, stromal yellow-white infiltrates composed of inflammatory cells, and varying degrees of corneal stromal thinning (minimal to full thickness) adjacent to the limbus. [6]

In severe cases, the peripheral cornea is progressively destroyed circumferentially, and the central corneal is also damaged.

PUK accompanied by necrotizing scleritis almost always indicates the presence of a potentially lethal systemic disease. [4]

The anterior chamber should be evaluated for depth and inflammation.

A posterior segment examination is typically indicated to help determine the underlying etiology.


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