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Ophthalmology and Visual Sciences

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Peripheral ulcerative keratitis (PUK)

Contributor: Jesse Vislisel, MD

Photographer: Stefani Karakas, CRA

Peripheral ulcerative keratitis (PUK) is an autoimmune-mediated corneal infiltration associated with systemic autoimmune and inflammatory diseases. It is most commonly associated with rheumatoid arthritis, but can also be associated with Wegener's granulomatosis, polyarteritis nodosa, lupus, scleroderma, and other inflammatory diseases. PUK is usually unilateral and peripheral, due to the proximity to the conjunctival vasculature. There is typically an epithelial defect overlying the infiltrate and associated corneal stromal thinning or melting. The lesions will stain positively with fluorescein if there is an overlying epithelial defect.

The patient in these photographs was later diagnosed with Wegener's granulomatosis upon systemic rheumatologic workup.

See related case

Peripheral ulcerative keratitis

Peripheral ulcerative keratitis, slit lamp image

Peripheral ulcerative keratitis, fluorescein stained


Another example of PUK
contributed by Lorraine Provencher, MD

Another example of PUK


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last updated: 8/8/2017. Originally posted: 8/25/2014