Keratitis (marginal)


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Inflammatory response of the peripheral cornea to bacterial (e.g. Staphylococcal) exotoxins rather than direct inoculation.

Predisposing factors

Bacterial (e.g. Staphylococcal) blepharitis or meibomitis
Condition tends to be recurrent

Symptoms of marginal keratitis

Ocular discomfort (foreign body sensation, increasing to pain)
Red eye

Signs of marginal keratitis

Stromal infiltrate, which may be round or arcuate, single or multiple, unilateral or bilateral. Infiltrates are typically adjacent to the limbus and separated by an interval of clear cornea.
Overlying epithelial loss may occur resulting in ulcer formation which stains with fluorescein
Ulcer stains with fluorescein
Hyperaemia of adjacent limbus
Hyperaemia and oedema of adjacent bulbar conjunctiva

Differential diagnosis

Other causes of ulceration of the peripheral cornea:

Management by optometrist

Practitioners should work within their scope of practice, and where necessary seek further advice or refer the patient elsewhere

Non pharmacological

Initial management of marginal keratitis should focus on addressing predisposing factors

Regular lid hygiene for associated blepharitis (see CMG on Blepharitis (Lid Margin Disease))
(GRADE*: Level of evidence=moderate, Strength of recommendation=strong)

Sunglasses to ease photophobia
(GRADE*: Level of evidence=low, Strength of recommendation=strong)


Ocular lubricants for symptomatic relief (drops for use during the day, unmedicated ointment for use at bedtime)
(GRADE*: Level of evidence=low, Strength of recommendation=strong)

Systemic analgesia if needed: paracetamol, aspirin or ibuprofen
(GRADE*: Level of evidence=low, Strength of recommendation=strong)

Marginal keratitis is a self-limiting condition. Nevertheless, it is conventional to give pharmacological treatment with a view to relieving symptoms and shortening the clinical course. However, this practice is not supported by evidence from clinical trials.

The concurrent use of topical antibiotic (e.g. gutt chloramphenicol 0.5%) to reduce bacterial load, in addition to topical steroid (e.g. gutt prednisolone sodium phosphate 0.5% or gutt loteprednol 0.5% for two weeks) to reduce inflammation, is theoretically justified and commonly used. However, the immunosuppressive effect of the steroid enhances the risk of infection
(GRADE*: Level of evidence=low, Strength of recommendation=weak)

NB All patients on topical steroid drops or ointment should have their intraocular pressures monitored (see Clinical Management Guideline on Steroid Glaucoma)

Management category

B3: management to resolution
If persistent or recurrent, refer to ophthalmologist

Possible management in secondary care or local primary/community pathways where available

Additional guidance may be available

Microbiological cultures of lesion and lid margins if uncertainty of diagnosis.

Evidence base

*GRADE: Grading of Recommendations Assessment, Development and Evaluation (

Sources of evidence

Chignell AH, Easty DL, Chesterton JR, Thomsitt J. Marginal ulceration of the cornea. Brit J Ophthalmol 1970;54:433-40

Ficker L, Seal D, Wright P. Staphylococcal infection and the limbus: study of the cell-mediated immune response. Eye (Lond). 1989;3 ( Pt 2):190-3

Mondino BJ. Inflammatory diseases of the peripheral cornea. Ophthalmology. 1988;95(4):463-72


What is Marginal Keratitis?

This is a slightly unusual condition caused by a reaction to the presence of bacteria (germs) near the eye, for example on the edges of the eyelids. It is an inflammation, not an infection. Patients experience redness, watering and pain in the eye. A shallow ulcer may develop at the edge of the cornea (the clear window of the eye), which can resemble a number of other conditions including infection. 

How is Marginal Keratitis managed?

The condition usually resolves by itself, but it may be dealt with more quickly if steroid and antibiotic drops are prescribed. If blepharitis (inflammation of the edges of the eyelids) is typically the cause, this should be treated. Sunglasses will help with any light sensitivity.

Keratitis (marginal)
Version 13
Date of search 02.10.23
Date of revision 27.11.23
Date of publication 23.01.24
Date for review 01.10.25
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