Marginal keratitis
✍ A common inflammatory reaction due to hypersensitivity type IV to staphylococcal exotoxin.
✍ Often seen in patients with atopy, rosacea, or chronic blepharitis.
✅ Clinical features of Marginal keratitis
✍ symptoms of marginal keratitis
☝ Pain
☝ FB sensation
☝ redness (may be sectoral or adjacent to lid margins)
☝ photophobia
☝ tearing
☝ dropped VA.
✍ signs of marginal keratitis
☝ Sterile, white, subepithelial peripheral corneal infiltrate
☝ most commonly at 2, 4, 8, and 10 o’clock
☝ may spread circumferentially to coalesce
☝ a perilimbal clear zone of cornea is preserved
☝ epithelial ulceration (stain with fluorescein)
☝ vascularization may occur.
✅ Treatment of Marginal keratitis
✍ Topical steroid/antibiotic
☝ betamethasone 0.1% 4×/d for 1wk
☝ then 2×/d for 1 wk
☝ chloramphenicol 0.5% 4×/d for 2wk to hasten resolution.
✍ Treat associated blepharitis or rosacea
☝ Oral antibiotics:
• a tetracycline (doxycycline 100mg 1×/d)
for 3months
• oxytetracycline 500mg 2×/d for 12wk
• tetracyclines are contraindicated in
1- children under 12
2- pregnant and breast feeding women
3- in hepatic or renal impairment
• a macrolide (erythromycin 500mg 2×/d) is an alternative once tetracycline is contraindicated
☝ lid hygiene
☝ ocular lubricants
☝ If moderately severe
• consider topical steroids±antibiotics (dexamethasone 0.1%±chloramphenicol 0.5%).
• Use with caution if significant stromal thinning, since keratolysis may be accelerated.
☝ If very severe (threatened corneal perforation)
• systemic immunosuppression is usually necessary (azathioprine or mycophenolate).
Marginal keratitis Videos:
Keratitis – Marginal keratitis CRASH! Medical Review Series. Paul Bolin, M.D. video
Marginal keratitis PPT ( power point presentations ):
Keratitis DR. ALI RAZA Associate ProfessorHead of Department Ophthalmology Holy Family Hospital Rawalpindi PPT
Peripheral ulceartive keratitis by Dr.vijay joshi PPT
Keratitis PPT
Normal Ocular Flora • Bacterial colonization of the eyelid margin and conjunctiva is normal and can be beneficial by competitively inhibiting pathogenic strains. The spectrum of normal ocular flora varies with the age and geographic locale of the host. In the eye of an infant delivered vaginally, multiple bacterial species predominate, including Staphylococcus aureus, Staphylococcus epidermidis, streptococci, and Escherichia coli; streptococci and pneumococci predominate during the first 2 decades of life and other coagulase-negative staphylococci, S aureus, and diphtheroids remain some of the most common species . Nonpathogenic colonization of the eyelid margin with Demodex folliculorum and Demodex brevis also becomes more common with age, with these parasites becoming almost ubiquitous. The use of topical antibiotics or corticosteroids for conditions such as ocular surface disease may alter the spectrum of eyelid and conjunctival flora. Few bacteria can overcome intact epithelium • Few bacteria can overcome intact epithelium. Those that can, include • Neisseria gonorrhoeae • Neisseria meningitidis • Corynebacterium diphtheriae • Shigella spp • Haemophilus influenzae biotype III (formerly Haemophilus aegyptius) • Listeria monocytogenes.
