Cornea
Peripheral Ulcerative Keratitis
Also known as: PUK, peripheral ulcerative keratitis, peripheral corneal melt, corneal melt vasculitis, limbal ulceration, rheumatoid corneal melt, wegener keratitis, peripheral corneal thinning
Filed as: Emergency
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
A sight-threatening, limbus-adjacent corneal ulceration caused by immune-mediated mechanisms rather than infection. Characterised by crescent-shaped peripheral corneal thinning and ulceration, often with an overhanging edge. Strongly associated with systemic vasculitis, particularly rheumatoid arthritis, GPA (Wegener's granulomatosis), and polyarteritis nodosa. The discovery of PUK should prompt urgent systemic investigation — associated systemic vasculitis carries significant mortality if untreated.
Recognition
Symptoms: what patients report
- Unilateral or bilateral eye pain.
- Redness.
- Photophobia and tearing.
- Reduced vision if ulceration involves the visual axis or is severe.
- History of systemic autoimmune or vasculitic disease: rheumatoid arthritis, GPA, SLE, polyarteritis nodosa, relapsing polychondritis.
- Adjacent scleritis is common — deep boring pain from scleritis accompanies PUK.
Signs: what the examination shows
- Peripheral corneal ulceration: crescent-shaped stromal thinning and epithelial defect at the limbus.
- Overhanging edge of the ulcer — the central edge of the ulcer overhangs the thinned stroma.
- Fluorescein staining of the ulcer base.
- Adjacent conjunctival injection, scleritis, or episcleritis.
- Peripheral corneal vascularisation (pannus) in chronic disease.
- Descemetocele (Descemet's membrane protrudes as a bleb if the stroma thins completely).
- Corneal perforation in advanced untreated disease.
What OptoGuide™ covers for peripheral ulcerative keratitis
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Peripheral Ulcerative Keratitis — EyeWiki
- Anterior Eye Disease and Therapeutics A-Z (Bruce & Loughnan) — standard reference text
- Peripheral Ulcerative Keratitis Due to Systemic Diseases. Sura AA, McCallum RM. Current Opinion in Ophthalmology. 2022;33(6):543-550.
- Visual Outcomes of Patients With Peripheral Ulcerative Keratitis and the Effect of Immunosuppression-a 6-Year Experience in Queensland, Australia. Li Y, McKelvie J, McLintock C. Eye & Contact Lens. 2022;48(7):283-288.
- Peripheral Ulcerative Keratitis: Pathogenesis, Diagnosis, and Multimodal Management. Guerrero-Acosta JC, Ortiz-Morales G, Vera-Duarte GR, et al. Journal of Clinical Medicine. 2026;15(3):1264.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.