Biologics in peripheral ulcerative keratitis

•Biological therapy in refractory PUK is becoming an increasingly prevalent and effective treatment modality.•Treatment outcomes for patients with PUK have improved over the past two decades with the more widely spread use of DMARDs and biologics.•The current evidence base for biologic efficacy is poor and subject to high risk of bias, however from that available appears to be effective in treating PUK.•Biologic therapies are associated with significant increased rates of infection. Over the past two decades biologic therapies have seen a rapid uptake in the management of ocular inflammation. Peripheral ulcerative keratitis (PUK), once a harbinger of blindness and mortality in refractory rheumatological disease, is now increasingly being treated with these agents. We conducted a review to evaluate the evidence base for this application and to provide a road map for their clinical usage in PUK, including dosage and adverse effects. A literature search across Medline, Embase and Cochrane Database of Systematic Reviews was undertaken to identify all patients with PUK that were treated with a biologic in a peer viewed article. Overall, whilst the evidence base for biologic use in PUK was poor, reported cases demonstrate an increasingly powerful and effective role for biologics in refractory PUK. This was particularly the case for rituximab in PUK secondary to granulomatous with polyangiitis.