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Br J Ophthalmol 2007;91:570-575 doi:10.1136/bjo.2006.105452
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Clinical characteristics of Mooren’s ulcer in South India

  1. Muthaiah Srinivasan1,
  2. Michael E Zegans2,*,
  3. Joseph R Zelefsky3,
  4. Arunava Kundu1,
  5. Thomas Lietman2,
  6. John P Whitcher2,
  7. Emmett T Cunningham, Jr2,†
  1. 1Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
  2. 2Department of Ophthalmology, The Francis I Proctor Foundation, University of California, San Francisco School of Medicine, San Francisco, California, USA
  3. 3Department of Ophthalmology, New York University School of Medicine, New York, New York, USA
  1. Correspondence to: Dr E T Cunningham Jr West Coast Retina Medical Group, Inc, 185 Berry Street, Lobby 5, Suite 130, San Francisco, California 94107-1739, USA; emmett_cunningham{at}yahoo.com
  • Accepted 2 October 2006
  • Published Online First 11 October 2006

Abstract

Aim: To describe the clinical characteristics at presentation of a large cohort of patients with Mooren’s ulcer in South India.

Methods: The medical records of patients with Mooren’s ulcer examined in the cornea clinic at Aravind Eye Hospital Madurai, Tamil Nadu, India, over a 10-year period were reviewed in this retrospective observational case series.

Results: The cohort contained 242 eyes of 166 patients. All patients were from South India, and men outnumbered women by a ratio of 4.7:1. The median and mean ages at presentation were 65 and 61 years, respectively, with a range of 13–95 years. One eye was affected in 90 of 166 (54%) patients. Visual acuity in the affected eye at presentation ranged from 6/6 to light perception, and was 6/12 or better in 34 of 242 (14%) eyes, between 6/12 and 3/60 in 168 (69%) eyes, and worse than 3/60 in 40 (17%) eyes. Partial peripheral corneal ulceration was observed in 222 (92%) eyes, complete peripheral corneal ulceration was observed in 15 (6%) eyes and total corneal ulceration was observed in 5 (2%) eyes. For those 222 eyes with partial peripheral ulceration, 152 (68%) showed temporal involvement, 129 (58%) showed nasal involvement, 116 (52%) showed inferior involvement and 30 (14%) showed superior involvement. Perforation was observed in 26 (11%) eyes, and was more common in eyes with peripheral as compared with total ulceration (p<0.001). Identified risk factors in the cohort included evidence of prior corneal surgery (22%), corneal trauma (17%) and corneal infection (2%).

Conclusions: Mooren’s ulcer is a rare and potentially blinding eye condition observed not infrequently in the cornea clinic at Aravind Eye Hospital. Men are affected more often than women and may present with either unilateral or bilateral disease. Perforation is observed in approximately 1 in 10 affected eyes at presentation and occurs most often in the setting of peripheral ulceration. The occurrence of prior corneal surgery, trauma or infection in nearly one third of patients supports theories of exposure to corneal antigen in the pathogenesis of this disorder.

Footnotes

  • ↵* Current address: Section of Ophthalmology, Department of Surgery, Dartmouth Medical School, Lebanon, New Hampshire, USA.

  • ↵† Current address: Departments of Ophthalmology, California Pacific Medical Center, San Francisco, California, and Stanford University, Stanford, California, USA.

  • Published Online First 11 October 2006

  • Competing interests: None declared.

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