5.10 Keratitis, Marginal

eyes.nhs.scot/
Eyecare Guidelines/
Section 5 - Cornea/
5.10 Keratitis, Marginal

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

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