Date of last review: Due to be updated

Differential diagnosis

  • Contact lens-associated microbial keratitis
  • Contact lens-associated corneal infiltrate
  • Rosacea keratitis
  • Mooren’s ulcer
  • Peripheral ulcerative keratitis associated with rheumatoid arthritis or other systemic collagen vascular disease
  • Corneal phlyctenulosis
  • Terrien’s marginal degeneration
  • Herpes simplex keratitis

Possible management by Optometrist

Treatment

  • Treat infection with antibiotic
    • Ask if allergic to Chloramphenicol
    • If not, supply Chloramphenicol 1% eye ointment 3 times daily for a week
    • If allergic to Chloramphenicol, or pregnant, supply Fusidic acid 1% liquid gel twice a day for a week
  • If no suspicion of herpes simplex keratitis, treat inflammation with
    • PoM Prednisolone sodium phosphate 0.5% 2 times daily for a week
  • Ask patient to return in one week for review, or sooner if symptoms worsen
    • Re-examine the patient
    • If healed: Discharge
  • If not healed, phone ophthalmology department to arrange an urgent appointment

Advice

  • Sunglasses to ease photophobia
  • Refer to local Pharmacist for analgesia for pain relief (Paracetamol or Ibuprofen; dose depends on age)
  • Marginal keratitis is a self-limiting condition which may recur
    • Offer to review patient, if symptoms recur
    • Regular lid hygiene for associated blepharitis will help limit recurrence

Management Category

  • Management to resolution
  • Refer to ophthalmologist if:
    • Anterior chamber cells present
    • Contact lens wearer
    • Children should always be referred

Possible management by Ophthalmologist

  • As above