✅ peripheral corneal thinning DD list
✍️ Autoimmune diseases ( RA,wegener,PAN,RPC,SLE)
✍️ Bacterial keratitis
✍️ Terren degeneration
✍️ Mooren ulcer
✍️ Marginal keratitis
✍️ Dellen
✍️ Sclerokeratitis
✍️ PMD
✍️ neurotrophic or exposure keratopathy
✍️ furrow degeneration
✍️ Ocular rosacea
✍️ Previous corneal or limbal surgery
✍️ Dry eye syndrome
✍️ Vernal keratitis
✅ Describe well what u see in peripheral corneal thinning
✍️ Site
✍️ Size
✍️ Associated signs
☝️stromal infiltration
☝️vascularisation
☝️ ulceration
☝️pain
☝️infection
☝️corneal or limbal or even scleral lesion
☝️AC reaction
☝️eyelid pathology
• scars
• chronic blepharitis
• surface telangectasia
• paralyzed
Exclude systemic associated autoimmune diseases ( clinically and lab)
Exclude from history
✍️ chronic CL wear
✍️ seasonal conjunctivitis
✅ Exclude DES with schirmer test
✅ Test corneal sensation
✅ Never Diagnose Mooren ulcer unless u exclude all local and systemic causes as it’s a diagnosis of exclusion ( may be associated with hepatitis C)
✅peripheral corneal thinning treatment:
✍️ TTT of the cause
✍️ Systemic causes should be coordinated with internist and rheumatologist
✍️ Topical
☝️ Antibiotics ( doxycycline, erythromycin)
☝️Ascorbic acid ( vit C)
☝️ Frequent PF tear substitute
☝️Cycloplegic ( pain, AC reaction)
☝️Systemic steroid or immunosuppressive ( systemic causes)
☝️Local steroid can be used in mooren ulcer
☝️Conjunctival or amniotic membrane graft
☝️keratoplasty may be required in severe resistant cases
☝️Intimate frequent F/up visits required in severe cases ( avoid perforation)