Current Issue

Purpose

To report a rare case of Mooren’s ulcer in a healthy young male without systemic autoimmune disease, and to highlight the effectiveness of conjunctival resection as therapy for cases unresponsive to medical management.

Case report

A 34-year-old immunocompetent male presented with progressive peripheral corneal ulceration in the left eye. Extensive systemic and infectious evaluations, including rheumatologic, immunologic, and microbiological testing, were unremarkable. Human leukocyte antigen genotyping was DR17(03)-negative and DQ2-positive. Rheumatological evaluation yielded no definitive systemic diagnosis. Despite immunosuppressive therapy with adjuvant medications, the epithelial defect and stromal inflammation persisted. The patient underwent conjunctival resection, resulting in marked reduction in inflammation, rapid re-epithelialization, and structural stabilization of the cornea. Histopathology of excised conjunctiva showed nonspecific inflammation without granulomatous changes, vasculitis, or neoplastic features. During follow-up, patient remained in remission with visual acuity preserved at 6/6 bilaterally and no recurrence.

Conclusion

Mooren’s ulcer is rare but vision-threatening. Early recognition, comprehensive evaluation, and timely surgical intervention can be vision-saving. This case highlights the role of a multidisciplinary approach and supports conjunctival resection as a useful adjunct in refractory disease. Long-term follow-up is essential.

Herpes zoster ophthalmicus (HZO) is a manifestation of varicella-zoster virus (VZV) reactivation involving the ophthalmic division of the trigeminal nerve, carrying significant risk of vision-threatening complications. Diplopia in HZO is often attributed to cranial nerve palsy, although orbital myositis remains a rare and underrecognized cause. We present a 79-year-old male who developed right-sided headache, binocular diplopia, and a V1 vesicular rash two weeks after receiving the recombinant zoster vaccine. Examination revealed restriction of extraocular movements without a localizing cranial nerve pattern, raising suspicion for orbital myositis. Neuroimaging was unremarkable, and VZV polymerase chain reaction confirmed the diagnosis of HZO. The patient received antiviral therapy and was discharged in stable condition after three days. This case highlights HZO presenting with suspected orbital myositis in temporal association with vaccination and underscores the need for vigilance for uncommon neuro-ophthalmic manifestations, as early recognition and treatment are essential to prevent vision-threatening complications. Given the patient's advanced age, this case also emphasizes the possibility that age-related immunosenescence may contribute to VZV reactivation and the development of HZO-related ocular complications. Potential therapeutic approaches targeting age-related immune dysfunction are also considered.