The CMGs offer information on the diagnosis and management of a range of conditions that present with varying frequency in primary and first contact care.
Marginal keratitis is an inflammatory response of the peripheral cornea to the presence of bacteria near the eyelid. It tends to be recurrent. Symptoms can include ocular discomfort, lacrimation, red eye and photophobia. This Clinical Management Guideline outlines the aetiology, signs and symptoms and evidence-based recommendations for diagnosing and treating marginal keratitis. It includes non-pharmacological management approaches, pharmacological treatment options, and outlines when referral may be appropriate for persistent or recurrent cases.
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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) - 17 February 2026 The aetiology section has been revised to include information on the pathophysiological mechanism that causes the inflammation observed in marginal keratitis. The signs section has been updated to highlight that areas of the cornea in direct contact with the lid margins are more likely to be affected in the presence of blepharitis. The pharmacological management section has been amended to highlight the need for close monitoring for potential side effects with steroid treatment and the cases where oral antibiotics may be considered as a treatment option.
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