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Peripheral ulcerative keratitis - External and Internal Eye
Other Resources UpToDate PubMed

Peripheral ulcerative keratitis - External and Internal Eye

Contributors: Aditi Jani MD
Other Resources UpToDate PubMed


Peripheral ulcerative keratitis (PUK) is an inflammatory thinning and ulceration of the cornea as a result of an autoimmune condition. Causative autoimmune diseases include:
Of these, rheumatoid arthritis is the most common, resulting in 32%-42% of PUK patients.

PUK affects 3 persons per million per year. There is no predilection by sex, but PUK more commonly affects patients after their fourth or fifth decade.

Patients present with ocular redness, pain, tearing, photophobia, and decreased vision. The classic presentation is a crescent-shaped white ulcer on the peripheral edge of the cornea.

Cases are mostly unilateral but can be bilateral. About 36%-66% of PUK cases can be associated with a scleritis, and a wider incidence of cases can be associated with anterior uveitis. The worst complications of PUK are corneal perforation or scleral perforation from an associated necrotizing scleritis. These complications need immediate surgical intervention to prevent infection and vision loss.


H16.009 – Unspecified corneal ulcer, unspecified eye

416473005 – Peripheral ulcerative keratitis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Corneal degenerations:
  • Terrien's marginal degeneration
  • Pellucid marginal degeneration
  • Furrow degeneration
Infectious / inflammatory processes: Local factors:
  • Exposure keratopathy
  • Neurotrophic keratoconjunctivitis
  • Trauma
  • Surgical complications

Best Tests

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:01/21/2021
Last Updated:05/08/2023
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Peripheral ulcerative keratitis - External and Internal Eye
A medical illustration showing key findings of Peripheral ulcerative keratitis : Photophobia, Vision loss, Corneal ulcer, Conjunctival injection, Ocular pain
Copyright © 2023 VisualDx®. All rights reserved.