Case report: bilateral Mooren ulcer in association with hepatitis C

Effect of Anti-TNF Treatment on Mooren's Ulcer: A Case Series and Review of the Literature

PURPOSE

To report the efficacy of systemic anti-TNF agents in Mooren's ulcer.

DESIGN

Retrospective, consecutive case series.

METHODS

We report on clinical characteristics and outcome of five patients with Mooren's ulcer with anti-TNF treatment.

RESULTS

During a mean follow-up of 30 months, relief of symptoms and arrest of corneal melting were observed in all eyes. Systemic corticosteroid treatment could be discontinued or reduced to threshold levels. No patient experienced adverse effects on bDMARDs.

CONCLUSIONS

Our results suggest that bDMARDs are effective in Mooren's ulcer unresponsive to conventional treatment. This is in line with accumulating evidence in the current literature. Therefore, more targeted immunomodulatory approaches might be an effective first-line therapy in the future.

Treating Mooren's Ulcer - Squeezing Water From a Stone

Mooren's ulcer, a rare ophthalmic disease, presents clinically as a painful, chronic, peripheral corneal ulceration of unknown etiology with some autoimmune origin evidence. It begins with an intense limbal inflammation, leaving behind an opaque cornea. If left untreated, progressive damage and corneal degeneration can lead to permanent loss of vision. Herein, we present a classic case of Mooren's ulcer in the right eye of a 60-year-old male patient with no known comorbid condition. No underlying systemic disorder being the rarity in our case, the cause remains idiopathic. The patient was previously diagnosed with having Mooren's ulcer in his left eye 10 years ago. Despite multiple topical treatments and surgical interventions, there was a complete loss of vision. He presented exaggerated manifestations, including pain, redeye, watery eye, photophobia, and the progressive decline of vision. A combination of multiple pharmacological and surgical interventions, including lateral tarsorrhaphy, amniotic membrane grafting, conjunctival flap, and scleral patch graft, was tried to ameliorate the affected eye but failed to salvage the eye permanently.