Herpes Viral Co-Infection in Benign Mooren’s Ulcer

Purpose To evaluate the incidence, clinical characteristics, and possible herpes viral etiology of Mooren’s ulcer.Methods A retrospective chart review of 29 eyes in 29 patients diagnosed with Mooren’s ulcer was performed to evaluate the incidence of co-infection with herpes epithelial keratitis during the episode of Mooren’s ulcer.Results Eleven of the 29 eyes showed a delayed response to the initial immunosuppressive treatment. Using polymerase chain reaction analysis of collected tear samples and corneal epithelial debris, 5 of those 11 eyes were diagnosed with simultaneous Herpes simplex keratitis (HSK) infection at both the first and recurrent episodes. At recurrence, simultaneous immunosuppressive and antiviral treatment accelerated patient recovery, compared with the sequential treatment (antivirals after initial immunosuppressives) of the 1st episode (p < 0.01).Conclusions Idiopathic Mooren’s ulcer can be related to peripheral HSK co-infection. During co-infection, simultaneous antiviral and immunosuppressive treatment should be considered to prevent aggravating the peripheral HSK while treating the underlying Mooren’s ulcer.