Purpose To evaluate aetiology, demographic profile, clinical features and outcomes in cases of peripheral ulcerative keratitis (PUK).

Methods Seventy-six eyes of 65 consecutive patients with PUK were evaluated in this prospective interventional study over an 18 month period, which were followed for 3 years. The main outcome measures were sociodemographic profile, aetiology, clinical features, management strategies and outcome.

Results Sixty per cent (39/65) of cases were men and mean age was 45.5±17.9 years. Two-thirds (43/65) of the patients were from rural areas with majority (48/65) belonging to low socioeconomic status. Unilateral disease was present in 83% of patients (54/65) with nasal involvement in 60.5% (46/76) cases. The most common aetiology was Mooren's ulcer (31.5% cases (24/76 eyes)) followed by infection and systemic collagen vascular disease. Meibomian gland dysfunction (17/76: 22.3%) was the most common extraocular association and complicated cataract (12/76:15.7%) was the most common intraocular abnormality. In mild and moderate cases, no significant visual improvement was observed (p=0.085 and p=0.156) as compared with the pretreatment status. Surgical treatment was successful in maintaining anatomical integrity in 83.3% (30/36) eyes. Recurrence of the disease was seen in one eye in moderate disease and three eyes in severe disease.

Conclusions Mooren's ulcer followed by collagen vascular diseases and infection are important causes of PUK in developing countries. Surgical intervention in perforated cases had good anatomical success and visual prognosis.