- Abnormalities of the Pupil
- Atopic Keratoconjunctivitis (AKC)
- Basal cell carcinoma (BCC) (periocular)
- Blepharitis (Lid Margin Disease)
- CL-associated Papillary Conjunctivitis (CLAPC), Giant Papillary Conjunctivitis (GPC)
- Cellulitis, preseptal and orbital
- Chalazion (Meibomian cyst)
- Concretions
- Conjunctival pigmented lesions
- Conjunctival scarring
- Conjunctivitis (Acute Allergic)
- Conjunctivitis (bacterial)
- Conjunctivitis (viral, non-herpetic)
- Conjunctivitis (seasonal & perennial allergic)
- Conjunctivitis, Chlamydial
- Conjunctivitis medicamentosa (also Dermatoconjunctivitis medicamentosa)
- Corneal (or other superficial ocular) foreign body
- Corneal Transplant Rejection
- Corneal abrasion
- Corneal hydrops
- Dacryocystitis (acute)
- Dacryocystitis (chronic)
- Dry Eye (Keratoconjunctivitis Sicca, KCS)
- Ectropion
- Endophthalmitis (post-operative) (Exogenous endophthalmitis)
- Entropion
- Episcleritis
- Facial palsy (Bell's Palsy)
- Fuchs Endothelial Corneal Dystrophy (FECD)
- Glaucoma (chronic open angle) (COAG)
- Herpes Simplex Keratitis (HSK)
- Herpes Zoster Ophthalmicus (HZO)
- Hordeolum
- Keratitis (marginal)
- Keratitis, CL-associated infiltrative
- Microbial keratitis (Acanthamoeba sp.)
- Microbial keratitis (bacterial, fungal)
- Molluscum contagiosum
- Nasolacrimal duct obstruction (nasolacrimal drainage dysfunction)
- Ocular hypertension (OHT)
- Ocular rosacea
- Ophthalmia neonatorum
- Photokeratitis (Ultraviolet [UV] burn, Arc eye, Snow Blindness)
- Phthiriasis (pediculosis ciliaris)
- Pigmented fundus lesions
- Pinguecula
- Post-operative suture breakage
- Primary Angle Closure / Primary Angle Closure Glaucoma (PAC / PACG)
- Pterygium
- Recurrent corneal epithelial erosion syndrome
- Retinal Vein Occlusion
- Scleritis
- Steroid-related Ocular Hypertension and Glaucoma
- Sub-conjunctival haemorrhage
- Sub-tarsal foreign body (STFB)
- Trauma (blunt)
- Trauma (chemical)
- Trauma (penetrating)
- Trichiasis
- Uveitis (anterior)
- Vernal Keratoconjunctivitis
- Vitreomacular Traction and Macular Hole
- How to use the Clinical Management Guidelines
Keratitis (marginal)

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Contents
Aetiology
Toxic or hypersensitivity response to bacterial (e.g. Staphylococcal) exotoxins
Predisposing factors
Bacterial (e.g. Staphylococcal) blepharitis
Current or recent upper respiratory tract infection
Condition tends to be recurrent
Symptoms of marginal keratitis
Ocular discomfort increasing to pain
Lacrimation
Red eye
Photophobia
Signs of marginal keratitis
Ulcer (stromal infiltrate with overlying epithelial loss) which may be round or arcuate, single or multiple, unilateral or bilateral, adjacent to limbus, and separated from limbus by interval of clear cornea
Ulcer stains with fluorescein
Hyperaemia and oedema of adjacent bulbar conjunctiva
Differential diagnosis
Other causes of ulceration of the peripheral cornea:
- microbial keratitis
- contact lens-associated corneal infiltrative keratitis
- rosacea keratitis
- Mooren’s ulcer
- peripheral keratitis associated with rheumatoid arthritis or other systemic collagen vascular disease
- corneal phlyctenulosis
- Terrien’s marginal degeneration
- marginal herpes simplex keratitis
Management by optometrist
Practitioners should recognise their limitations and where necessary seek further advice or refer the patient elsewhere
Non pharmacological
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)
Pharmacological
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. However, the immunosuppressive effect of the steroid enhances the risk of infection
(GRADE*: Level of evidence=low, Strength of recommendation=weak)
Management category
B3: management to resolution
If persistent or recurrent, refer to ophthalmologist
Possible management by ophthalmologist
Microbiological cultures of lesion and lid margins
Investigation of patient’s immune status
Evidence base
*GRADE: Grading of Recommendations Assessment, Development and Evaluation (www.gradeworkinggroup.org)
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
Summary
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 develops 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 the cause, this should be treated.
Keratitis (marginal)
Version 12
Date of search 25.07.21
Date of revision 30.09.21
Date of publication 26.01.22
Date for review 24.07.23
© College of Optometrists
- Abnormalities of the Pupil
- Atopic Keratoconjunctivitis (AKC)
- Basal cell carcinoma (BCC) (periocular)
- Blepharitis (Lid Margin Disease)
- CL-associated Papillary Conjunctivitis (CLAPC), Giant Papillary Conjunctivitis (GPC)
- Cellulitis, preseptal and orbital
- Chalazion (Meibomian cyst)
- Concretions
- Conjunctival pigmented lesions
- Conjunctival scarring
- Conjunctivitis (Acute Allergic)
- Conjunctivitis (bacterial)
- Conjunctivitis (viral, non-herpetic)
- Conjunctivitis (seasonal & perennial allergic)
- Conjunctivitis, Chlamydial
- Conjunctivitis medicamentosa (also Dermatoconjunctivitis medicamentosa)
- Corneal (or other superficial ocular) foreign body
- Corneal Transplant Rejection
- Corneal abrasion
- Corneal hydrops
- Dacryocystitis (acute)
- Dacryocystitis (chronic)
- Dry Eye (Keratoconjunctivitis Sicca, KCS)
- Ectropion
- Endophthalmitis (post-operative) (Exogenous endophthalmitis)
- Entropion
- Episcleritis
- Facial palsy (Bell's Palsy)
- Fuchs Endothelial Corneal Dystrophy (FECD)
- Glaucoma (chronic open angle) (COAG)
- Herpes Simplex Keratitis (HSK)
- Herpes Zoster Ophthalmicus (HZO)
- Hordeolum
- Keratitis (marginal)
- Keratitis, CL-associated infiltrative
- Microbial keratitis (Acanthamoeba sp.)
- Microbial keratitis (bacterial, fungal)
- Molluscum contagiosum
- Nasolacrimal duct obstruction (nasolacrimal drainage dysfunction)
- Ocular hypertension (OHT)
- Ocular rosacea
- Ophthalmia neonatorum
- Photokeratitis (Ultraviolet [UV] burn, Arc eye, Snow Blindness)
- Phthiriasis (pediculosis ciliaris)
- Pigmented fundus lesions
- Pinguecula
- Post-operative suture breakage
- Primary Angle Closure / Primary Angle Closure Glaucoma (PAC / PACG)
- Pterygium
- Recurrent corneal epithelial erosion syndrome
- Retinal Vein Occlusion
- Scleritis
- Steroid-related Ocular Hypertension and Glaucoma
- Sub-conjunctival haemorrhage
- Sub-tarsal foreign body (STFB)
- Trauma (blunt)
- Trauma (chemical)
- Trauma (penetrating)
- Trichiasis
- Uveitis (anterior)
- Vernal Keratoconjunctivitis
- Vitreomacular Traction and Macular Hole
- How to use the Clinical Management Guidelines