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Findings

• Often chronic blepharitis
• Subepithelial marginal infiltrates, typically separated from the limbus by a clear zone ^{1 2}
• Epithelial defects are typically smaller than the infiltrates
• Fusion of smaller infiltrates and circular spread
• Spontaneous resolution (without treatment) usually occurs within 3-4 weeks

Treatment

• Topical steroid therapy (e.g., Dexafree (dexamethasone) 4x/day or FML (fluorometholone) 4x/day)
• Antibiotic coverage and treatment of accompanying blepharitis with Floxal (ofloxacine) and/or Tobrex (tobramycin) gtt/ointment (consider prescribing a combination preparation such as Tobradex)
• Lid hygiene for blepharitis
• Consider doxycycline p.o. (e.g., 100 mg 2x/day for 2 weeks, then 1x/day for 1 month, then 50-100 mg daily; Note: Erythromycin for children, pregnancy, or lactation) if recurring

Differential Diagnoses

• Peripheral Ulcerative Keratitis (PUK)
• Terrien’s Marginal Degeneration
• Bacterial Keratitis

Sources

• EyeWiki Marginal Keratitis
• The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition(2016)
• Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)
• ^1,2 Stiff AH, Ricca AM, Goins KM. Corneal Marginal Ulcer: Marginal keratitis with ulceration in a 45 year-old male. EyeRounds.org. posted March 14, 2017; Available from: https://EyeRounds.org/cases/249-corneal-marginal-ulcer.htm
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