A non-infectious, inflammatory infiltration of the peripheral cornea due to a staphylococcal hypersensitivity reaction.
- Marginal keratitis is a common condition caused by inflammation of the peripheral cornea
- A non-infectious, inflammatory infiltration of the peripheral cornea due to a staphylococcal hypersensitivity reaction.
- Marginal keratitis is usually caused by an auto-inflammatory reaction to staphylococcal antigen.
- Blepharitic lids rub against the cornea
- Strongly associated with blepharitis, particularly staphylococcal blepharitis
- As with other causes of keratitis, patients commonly presented with intense eye pain and photophobia
- There may be some degree of ciliary injection
- Close examination of the lids will commonly reveal blepharitis with crusting of the lids and meibomian gland drop out
- In severe cases, corneal ulceration may develop
- Look for Rosacea, seborrheic dermatitis
- Marginal keratitis is a clinical diagnosis and careful history taking and exam is important
- Slit lamp examination will reveal one or more stromal infiltrates involving the peripheral cornea
Red flags to suggest bacterial, viral, fungal, autoimmune disease
- Large epithelial defect (>1mm)
- Dense corneal infiltrate
- Dendritic or geographic lesions
- Peripheral corneal thinning
- Decreased corneal sensation
- Presence of anterior chamber cells
- History of contact lens wear, cold sores, autoimmune disease
- In the acute phase, topical steroids, commonly dexamethasone, are used to reduce inflammation. The majority of cases are self-limiting and will resolve with a short course of steroids, usually one week.
- Patients should be also advised on how to prevent future episodes through good lid hygiene – regular hot compress and wiping away any crusts or scales on the lids. See patient info leaflet below. There is a risk of recurrence in patients who do not adhere to good lid hygiene
- In atypical cases, contacting an ophthalmic specialist is essential. Excluding other sight threatening conditions such as bacterial corneal ulceration is important. See red flags above.
- Oral antibiotics may be considered for recurrent episodes associated with significant blepharitis: These include Doxycycline (not in children or pregnancy) or Erythromycin