Marginal Infiltrative Keratitis Etiology Symptoms Signs Differential

Marginal Infiltrative
Keratitis
Etiology
Dr. Victor Malinovsky
2006
Symptoms
Acute or subacute onset with frequent
past history of prior attacks, most often
unilateral attacks, often worse in AM
Redness, foreign-body sensation, pain,
and photophobia
Visual acuity rarely affected
Signs
Lucid (clear) interval between limbus and
infiltrate
Sector conjunctival injection
Size variable of 0.5 to 2 mm, single or multiple,
may coalesce into elongated chain lesion
Anterior chamber is usually quiet
Marginal ulcer -Same lesion with an overlying
epithelial defect. Infiltrate stains superficially and
clear within minutes and ulcers stain deeply and
tend to produce amorphous spreading
Secondary corneal scars and
neovascularization
Staphylococci exotoxin produces an
antigen/antibiotic immune reaction
Sterile-infiltrate ulcer as opposed to live
bacteria in ulceration
Chronic Staphylococcal blepharitis:
blepharitis: Mild to
severe
Contact lens patients especially extended wear
more prone
More common in adult life
Signs
Blepharoconjunctivitis:
Blepharoconjunctivitis: May be
subclinical,
subclinical, inferior punctate staining
Marginal intra-epithelial infiltrate:
infiltrate: An
initial gray-white, round or crescent,
raised subepithelial,
subepithelial, anterior stromal
haze seen near limbus;
limbus; circumferential
with limbus,
limbus, epithelium intact with
superficial staining
Most vulnerable sites at 2,4,10 and 8:00
of peripheral cornea, where lid margin
crosses limbus and more toxins present
Differential Diagnosis
Sterile cultures
Marginal herpetic keratitis (epithelial
first then stroma)
stroma)
Phylctenular ulcer, scleritis, vasculitis,
CT disease, Mooren’
Mooren’s ulcer are other
causes of marginal keratitis
1
Treatment
Topical solutions of 0.3% Tobrex or Ciloxan
or Ocuflox 2 gtt every 2 to 4 hours, plus
bacitracin,
bacitracin, erythromycin, polysporin ointment
at bedtime
Eyelid hygiene & warm compresses & D/C CL
wear
Cycloplegic if pain & A/C reaction: In office
Antibiotic/steroid combination treatment; e.g.,
Tobradex,
Tobradex, Blephamide,
Blephamide, Zylet or 1% Pred
Forte q4-6h with rapid taper; if ulcer
formation, no steroids for 24 to 48 hours
• New steroids: Vexol,
Vexol, Lotemax,
Lotemax, Flarex,
Flarex, or
Eflone
Chronic or Recurrent
Episodes
Oral doxycycline,
doxycycline, 100mg bid PO for 1
mo. then qd for 1mo.
Frequently Results in Nebula Scar
Formation and Pannus
2
Infiltrate
Lucid interval
3
4