We have read the article entitled “Late-onset Peripheral Ulcerative Sclerokeratitis Associated With Alkali Chemical Burn” by Iovieno and associates with interest. We congratulate the authors for calling ophthalmologists’ attention to this newly described condition. We would like to ask for the attitudes of the authors about using hyperbaric oxygen therapy for these cases.

Several possible causes of peripheral ulcerative keratitis (PUK), such as inflammation, vasculitis, infections, and ischemia, are mentioned in the text. Hyperbaric oxygen therapy is well known for its ability to prevent ischemia and promote wound healing by increasing the partial oxygen pressure in the blood. Hyperbaric oxygen supports oxygen-dependent collagen synthesis and attenuates cell apoptosis. Furthermore, it has been reported that hyperbaric oxygen can control inflammation and vasculogenesis by decreasing neutrophil adherence and downregulating the expression of intercellular adhesion molecule-1 and vascular endothelial growth factor. Hyperbaric oxygen can improve the potency of antibiotics and has antibacterial effects as well. Finally, hyperbaric oxygen stimulates the defense mechanisms against oxidative stress that plays a critical role in chemical injuries such as mustard-induced burns.

Regarding the features of hyperbaric oxygen noted above, we suppose that hyperbaric oxygen therapy would be advantageous in the treatment of PUK. We will be glad if the authors will share their ideas about this subject.