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Ulcer de Mooren bilatéral associé à la chirurgie du ptérygion chez un patient congolais mélanoderme. A propos d'un cas

Mooren’s ulcer is a rare, chronic peripheral ulcerative keratitis. His etiology is unknown. Herein, we report a case of bilateral Mooren’s ulcer that occurred after pterygium surgery.

A case report

A 39-year-old black man visited us on August 2th , 2014 complaining of a 6-year history of ocular pain, photophobia and decreased vision in both eyes. He underwent excision of pterygium in  both eyes 12 years before; with recurrence two years after excision in the left eye. He was diagnosed Mooren’s ulcer in the left eye in 2013 which was treated with topical corticosteroids with incomplete resolution. His past medical history was remarkable. Uncorrected visual acuity was 20/50 in the right eye and 20/60 in the left eye. Slit-lamp examination revealed recurrent pterygium at nasal side in both eyes, and crescent-shaped thinning of the peripheral cornea at the (nasal) limbus. Mooren’s ulcer was diagnosed from typical findings at Slit-lamp of a circumferential peripheral corneal ulcer with an overhanging and infiltrated edge at it central border. The involvement of collagen disease, including rheumatoid arthritis, was excluded from serological tests and medical history. No microorganism was detected and laboratory investigations performed for tuberculosis, syphilis,  HIV, hepatitis virus, Bartonella were all negative.

Immediately, the patient was given topical dexamethasone initiated 4 times daily, topical atropine  1% 3 times daily, prophylactic topical antibiotics 4 times daily. Two months later, topical steroid were tapered gradually according to the signs and symptoms. Four months after initial presentation, his BSCVA had improved to 20/25 in the right eye and 20/40 in the left eye. Slit-lamp examination showed no active corneal and conjunctival inflammation.

The case report illustrates the therapeutic benefit of corticosteroids in Mooren’s ulcer.

The causal relationship between the pterygium surgery and Mooren’s ulcer may be possible.