Late-onset Peripheral Ulcerative Sclerokeratitis Associated With Alkali Chemical Burn

PurposeTo report delayed-onset peripheral ulcerative keratitis (PUK) following alkali injury.DesignRetrospective case series.Methodssetting: Single institution (Cornea and External Disease Service, Moorfields Eye Hospital). participants: Six eyes of 5 patients with PUK and associated anterior scleritis that had a history of ocular alkali injury. observation procedure: Patients were identified among PUK patients seen at Moorfields Eye Hospital over a 20-year period. main outcomes measures: Patients' demographics, clinical features, treatment, and outcomes.ResultsRecurrent PUK with scleritis following alkali burns occurred in 5 male patients/6 eyes (median age: 22 years, range 18-38) several years after the chemical trauma (average: 6.4 years; range 3-12). Management of PUK in these patients was similar to PUK arising from other etiologies.ConclusionsIn this series of patients there was no evidence of an underlying vasculitic cause for the PUK. A localized autoimmune response may, however, be involved in the pathogenesis of these cases, as seen in an animal model of chemical injury or in late mustard gas keratitis. We hope that this case series will bring this newly described condition to the attention of ophthalmologists and that this may assist in their treatment, which, in this series, required systemic immunosuppressive therapy.