The College of Optometrists

MK requires emergency, aggressive antibiotic tx whereas clpu's are self limiting and require no tx.

To be safe, do you treat any focal infiltrate with bright overlying fluorescence as an emergency?

my supervisor says remember PEDAL

Pain is greater in MK

Epithelial breach occurs in both

Discharge is mucopurulent in MK

Anterior chamber reaction(flare) occurs in MK

Location is more central in MK.

If I saw a peripheral infiltrate with only mild pain and watery discharge with no flare or cells in anterior chamber and a peripheral location, would i be considered unsafe to stop lens wear and see the next day, if it's an ulcer it should regress.

erm - well yes and no. A peripheral ulcer of any type, including clpu is circular and does not hurt, unless it is combined with overwear. It may have an associated focal limbal redness nearby. It often has a mm or so of clear cornea between it and the limbus.

A Mk or even a corneal ulcer also starts in a quiet way. It tends to feel gritty, often with 6/6 vision. The big thing is that the corneal infiltrate asociated with it is deep in the stroma and the fl stain of the site of infection is not round like a perip ulcer - but any shape as the bacteria attacks the corneal epithelium in a 'wild fire' fashion - taking hte least line of resistance.

It is very hard to tel between the two early on - but practice makes perfect! PEDAL is realy when the MK is well established. Best to get second opinion from yr supervisor, but there is no need to panic.

If I see a perip staining spot which is sl raised, surrounded by clear cornea and with mild irritation and mild focal limbal redness. I would remove the cl and advise them to store it in the case (incase it needs culturing) BUT NEVER TO wear it again. I would educate them on risks of clpu and council them on health and safety. So I suspect a clpu. These can take ages to go away and can form a sunken area later on - a dellen. The can leave a small opaque patch with associated neovascular tag.

I would also advise then on lid hygeine as staph toxins is associated with clpu.

Then monitor it in a day or two - if it is MK or worse, then it will get worse. Serious things always get worse. You would have to tell them if it gets worse to go to casualty urgently. If you think that they won't come bac kor are generally noncompliant - then you better send them off to casualty.