Histopathology-based diagnosis of Mooren’s ulcer concealed beneath the pterygium on eye

ABSTRACT

Mooren’s ulcer (MU) is a chronic and painful ulcerative keratitis that is difficult to diagnose, especially when concealed beneath the pterygium, which is a common, benign, wedge-shaped, fleshy tissue growth of the conjunctiva extending onto the cornea. The coexistence of MU and pterygium is extremely rare. A 41-year-old man presented with a 2-month history of unprovoked redness, pain, and blurred vision in the right eye. Corneal epithelial defects around the pterygium head were noted upon slit-lamp examination and fluorescein staining. The patient was initially misdiagnosed with a corneal epithelial defect and pterygium. The initial treatments with anti-inflammatory and corneal epithelial growth promotion tear agents failed. Anterior segment optical coherence tomography (AS-OCT) showed corneal stromal lysis thinning, and in vivo confocal microscopy (IVCM) revealed marked inflammatory cell infiltration and stromal degeneration. We suspected the pathology was an immune-related or tumor-related corneal ulcer. The MU concealed beneath the pterygium was diagnosed by histopathological examination of a biopsy specimen that presented typical localized loss of the corneal epithelium and Bowman’s layer, stromal degeneration, and inflammatory cell infiltration. Finally, we performed lamellar keratoplasty (LKP) combined with pterygium excision surgery. The patient recovered with no complications or recurrence during the 1-year follow-up period. Few cases of MU concealed beneath the pterygium have been reported. It is beneficial to rule out the pathological changes concealed beneath the pterygium, combined with multiple means of examination such as slit-lamp examination, AS-OCT, and IVCM. A histopathological examination should be performed to establish a diagnosis.

KEYWORDS:

• Mooren’s ulcer
• pterygium
• histopathology
• lamellar keratoplasty
• case report

Acknowledgments

All authors have read and approved the manuscript. Specifically, YJ and SO designed this study, performed the literature search, and wrote the manuscript. XF, ZX, and HW also helped design this study and held to collect the clinical data.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/01478885.2022.2137666

Additional information

Funding

This study was supported by the National Natural Science Foundation of China [grant number 82101084, 82060173], China Postdoctoral Science Foundation [grant number 2021M69898], the Xiamen Science and Technology Program for Public Wellbeing [grant number 3502Z20209183] and Science and Technology Support Program of Guizhou Province [20204Y145]. The funders had no role in the study design, data collection and analysis, publishing decision, or preparation of the manuscript; Postdoctoral Research Foundation of ChinaPostdoctoral Research Foundation of China [2021M69898];