What is your approach to immunosuppression in patients with recurrent peripheral ulcerative keratitis or marginal keratitis who have active disease despite steroid therapy and no current evidence of rheumatologic disease?

Drs. @Dr. First Last and @Dr. First Last provide some excellent insight in their responses. In this question, it's stated the patient has active disease despite steroids. I would agree with both Drs. @Dr. First Last and @Dr. First Last that non-infectious PUK typically requires high-dose steroid (1m...

This is a good question and something that can eventually be frustrating to treat if your initial few therapies aren’t enough. First, I want to distinguish between peripheral ulcerative keratitis and what you may be referring to as staph marginal? Staph marginal are small peripheral ulcerations usua...

The terms peripheral ulcerative keratitis (PUK), marginal keratolysis, and corneal melt are all roughly equivalent. As Dr. @Dr. First Last wrote, it is important to exclude other conditions. Occasionally herpes simplex infection could mimic this. Mooren's ulcer and Terrien's marginal degeneration ar...

I agree with both my colleagues that there can be a "prozone" effect with the ANCA such that false negative results occur and antibodies to PR-3 or MPO are detectable. The disagreement is with the word "screening". I screen with the ANCA and request antibodies to MPO and PR-3 in circumstances in whi...