A 52-year-old male presented for consultation for scleral contact lens fitting OD. He has a history of a wedge corneal transplant on the right eye three years prior due to corneal perforation. He currently uses 1% prednisolone acetate b.i.d. OD and loteprednol b.i.d. OS. Prior to the perforation and starting the eye drops, his eyes were chronically very red OD > OS.

At his recent visit, his vision through the left eye is 20/20 through a +2.50D sphere lens. After scleral lens fitting OD, his vision was also 20/20. Figure 1 shows both eyes at that visit, the right eye with a scleral lens and the left without correction.

This patient was diagnosed with Mooren’s ulcer. The right eye had perforated due to extreme thinning and melting of the cornea three years prior and was successfully managed with a tectonic, wedge-shaped graft (Figure 2). The patient continues on prednisolone q.d. OD after the graft to both manage the graft as well as quiet any residual inflammation.

The left eye was also treated with loteprednol q.d. OS to quiet the eye long term. The right eye was successfully managed with a scleral lens for vision correction, while the left eye was corrected with spectacle lenses only. The patient continues in this modality of vision correction happily to date.

Mooren’s ulcer is a peripheral ulceration of the cornea, is painful, and is accompanied by adjacent limbal and conjunctival inflammation. The condition is rare, and the etiology is unknown, though it is thought to have an autoimmune basis. Diagnosis requires ruling out infectious or known systemic rheumatologic disease processes. Differential diagnosis also includes other corneal thinning disorders, such as pellucid marginal degeneration and Terrien’s marginal degeneration. In both cases, the accompanying inflammation with Mooren’s is uncharacteristic of either condition. More challenging differentials can include rheumatologic or systemic inflammatory disease and collagen vascular diseases.

Obviously, if the ulcer progresses to perforation, management becomes surgical to repair the cornea. For this, localized, tectonic grafts are utilized to restore the corneal integrity. In a pre-perforated state, management includes topical corticosteroids and other immunomodulating drugs such as cyclosporine or interferon. In cases in which topical medication cannot control the condition, conjunctival excision can be beneficial.