|Year : 1974 | Volume
| Issue : 2 | Page : 22-24
An analysis of ten cases of Mooren's ulcer
A Samuel Gnandoss
Eye Department, Erskine Hospital, Madurai, India
A Samuel Gnandoss
Eye Department, Erskine Hospital, Madurai
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gnandoss A S. An analysis of ten cases of Mooren's ulcer. Indian J Ophthalmol 1974;22:22-4
Mooren's ulcer (Ulcus Rodens; Chronic Serpigenious ulcer) is a marginal corneal degeneration occurring in older people and is seen bilaterally in 25% of cases. This marginal degeneration is considered to be a rare disease  and there are not many reports from this country  . The following is an analysis of ten cases of Mooren's ulcer seen by the author during the years 1970-1973.
| Materials and Methods|| |
Ten cases of Mooren's ulcer that attended the eye out-patient wing of Erskine Hospital, Madurai, were studied. A detailed history was taken. Complete haemogram, stool examination, Montoux test and bacterial examination of the ulcer were carried out. Careful general examination of the patients was done. These cases were treated either by conjunctival hooding after iodine cauterisation by keratoplasty or by cryo application with peritomy. Cryo application was done with Amoil's cryoprobe. Ten seconds applications (-40° C) followed by thawing were done to the margins (central and peripheral) as well as to the floor of the ulcer. This was repeated in those cases which did not show response in a single sitting.
| Observations|| |
Ten cases of Mooren's ulcer are analysed here. Out of these ten cases, six were in the age group of 50 to 59 years and four were in the age group of 60 to 69 years. All these cases were male.
Bilaterality was seen in four cases. Amongst the unilateral cases four occured in the right eye and two in the left eye. Two of these ten cases came in an advanced stage with the ulcerative process all round the cornea. Amongst the rest of the eight cases who came early, the lesion was seen in the infero-temporal quadrant in five cases, in the inferonasal quadrant in two cases and in the inferior quadrant in one case. Perforation was not seen in any case.
Investigations carried out to detect the probable aetiological factor were not contributory. History of injury was obtained in only one case. Montoux test was positive in two cases but there was no other evidence of tubercular lesion. Stool examination showed Entamoeba coli cyst in four cases. Ankylostoma doudenale was not seen in any of these case seven after repeated stool examination. Microbiological investigations did not reveal any pathogen, (investigations for viral aetiology were not carried out).
Five of these cases were treated by iodine cauterisation and conjunctival hooding after snipping off the ulcer margins. In two of them this was repeated. In all these cases there was recurrence of the ulcer within a period of one to two months. In one unilateral case, corneal grafting was done without any success. Regrafting was not attempted in this case. Cryotherapy was carried out on five eyes of four cases. In three eyes where the lesion was less than one-third of the circumference of the cornea the condition healed without recurrence.
| Comments|| |
Mooren's ulcer is considered to be a relatively rare disease. Thygeson  reported 6 cases of Mooren's ulcer out of the 200 cases of marginal ulcers. Kietzman  while reporting his series of 37 cases, found the incidence to be 1 in 2,200 of clinical cases.
Mooren's ulcer is common in the older age group - a fact borne out in this series also in which all the cases were above the age of 50 years. In this study, bilaterality was seen in 4 out of 10 cases (40.0%) while the incidence reported in the literature is 25%.
Although a century has passed since its first description, yet the aetiology of Mooren's ulcer has remained an enigma. Bacterial and viral aetiologies have not stood the test of time. Trauma, syphilis, tuberculosis, metabolic disorders, malnutrition, deficiency of Vitamin B, trophic disorders and changes in V cranial nerve or the sympathetic were inculpated at one time or other  . Investigations carried out in the present series also have not shed any light upon this aspect. It must be pointed out here that in a locality where intestinal parasites are so prevalent, none of the cases under discussion here showed infestation by Ankylostoma duodenale - a parasite incriminated as an aetiological agent by Kuriakose  . The frequent occurrence (40.0%) of Entamoeba coli in this series does not have any significance, since it is a harmless commensal in the intestine.
The treatment of Mooren's ulcer, even when instituted at an early stage, is unsatisfactory. Various authors have recommended various methods of therapy. The excision of overhanging edges and cauterisation either by physical or chemical means are usually not successful. Conjunctival flap after cauterisation may be helpful. Lederman  found radiation to be beneficial; Tarsorrhaphy  and delimiting Keratotomy  may be helpful. Similar good results were obtained with diathermy coagulation  , sclerectomy or repeated paracentesis. Linn  from an analysis of the literature feels that radiation, delimiting keratotomy and conjunctival flap are the most effective measures. Peritomy and cryo-applications of the ulcer edges have given encourging results  . Although not agreed by some, , . yet keratoplasty has been found to be the most effective treatment,  and this may have to be repeated before a permanent cure is effected. 
In the series under study, conjunctival hooding after iodine cauterisation did not arrest the ulcerative process Corneal grafting, performed in a single case, also failed. Cryotherapy was found to be effective in early cases; but in advanced cases this method of treatment was ineffective.
Wood and Kaufman  classified Mooren's ulcer into two types - a benign type seen in older individuals which responds well to surgical line of treatment, and a non-responsive type seen in younger patients. Although this study does not include any young patient, yet it may be assumed that the prognosis of this condition depends more upon the type of treatment instituted than on anything else.
| Summary|| |
Ten cases of Mooren's ulcer are analysed. Bilaterality was seen in 4 cases. All cases were males above the age of 50 years. The exact aetiology could not be detected in any of them. Treatment by conjunctival hooding and keratoplasty was not successful Cryoapplication gave encouraging results in early cases; but in advanced cases this was found to be ineffective.
| Acknowledgement|| |
The author thanks Mr. K. Balakrishnan for his secretarial help.
| References|| |
Aviel E., 1972, Brith. J. Ophthal, 56,481.
Duke-Elder S., 1965, System of Ophthalmology.
Vol. VIII Pt. 2, p. 914. Henry Kimpton, London.
Grana P.C., 1959, Arch. Ophthal, 62,
Harley R. D., 1951, AMA.Arch. Ophthal., 57,
Kanagasundaram, C.R., 1970, Tr. Ophthal, Soc. U.K.,
Kietzman B., 1968, Amer J. Ophth., 65,
Kuriakose. E. T., 1963, Amer. J. Ophthal, 55,
Lederman M., 1957, Brit. J. Ophthal, 41, 1.
Leigh A. G., 1966, Corneal Transplantation,
p. 274. Blackwell Scientific Publications, Oxford.
Linn J.G., 1969, Amer. J. Ophthal, 32,
Paton. R. T., 1955, Keratoplasty, p. 81.
The Blackiston Division, New York.
Somerset E. J., 195', Brit J. Opht al, 41,
Sorsby A., 1972, Modern Ophthalmology, Vol.
4. 2nd Edn., p. 793 Butterworths, London.
Thygeson P., 1947, Amer. Acad. Ophthal,
Wood T. O. and Kaufman H. E., 1971, Amer. J. Ophthal,
[Table - 1]