Peripheral Ulcerative Keratitis (PUK) is a major diagnostic and therapeutic challenge to all eye care providers. The myriad systemic associations of the same make the work more challenging and need a team approach combining ophthalmologist, internists and rheumatologist; for optimum patient outcome. Our work is a look at the patients presenting to a tertiary care eye hospital in India with this complex problem. We discuss the epidemiology, clinical presentation, classification ,management details and treatment outcomes of these patients. We hope that this work benefits the team ready to take up the challenging management of this multifactorial condition.