Marginal Keratitis: The Tree that Hides the Forest

Abstract

Peripheral ulcerative keratitis (PUK) is a rare manifestation of rheumatoid arthritis (RA). The progressive thinning of the peripheral cornea is secondary to immune complex disease. It may lead to blindness and reflect the presence of an active, potentially vasculitis both locally and systemically. We report here a rare case of PUK revealed by a marginal keratitis. The diagnosis of unilateral PUK with anterior scleritis complicating RA was made. The diagnosis must be made quickly because of the risk of perforation, but also because it may be the presenting manifestation of a serious systemic disease. It should be treated as an emergent situation.