Look at the periphery! - Marginal Keratitis
● Hypersensitivity reaction due to Staphylococcus Aureus exotoxins in the peripheral cornea
● Patients have associated Staphylococcal blepharitis/ conjunctivitis
Mechanism:
● Type III Hypersensitivity
● Antigen-antibody complexes deposited in peripheral cornea → complement pathway activated and neutrophil attraction → peripheral stromal infiltrates → epithelial breakdown and ulceration
Signs :
● Subepithelial- Stromal infiltrates at 2,4,8 and 10 o’clock positions
● 1-2 mm parallel to the limbus
● Clear margin between infiltrates and limbus
● Can lead to formation of marginal ulcer ● Findings of blepharitis present
● Course : Subepithelial infiltrates separated by clear zone → Spreads circumferentially → Bridging vascularisation → Resolution
Management :
● Topical steroids
● Treatment of associated blepharitis
Image from Rajan Eye Care Hospital
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