Staph marginal keratitis (Video)

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This video shows a sterile corneal infiltrate at the inferior limbus in an eye with blepharitis. This opacity is entirely sterile and occurs from a hypersensitivity reaction at the limbal vessels in the cornea. This eye was treated successfully with good lid hygeine and a mild steroid.

This entity is usually bilateral, and as you can see there is a clear zone at the edge of the limbus that isn’t affected.

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staphmarginal.wmv (3.3 meg, Windows video file)

Screenshots from this video

Staph marginal keratitis
This photo shows a sterile infiltrate near the limbus in an eye with significant inflammation from staph aureous infection of the eyelids. A hypersensitivity reaction occurs at the edge of the limbal vessels in the cornea. This eye was successfully treated by treating the lid disease and a mild steroid.
Marginal ulcer at limbus
This photograph shows a sterile infiltrate of the cornea caused by a hypersensitivity reaction to staph infection of the eyelids.
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Dr. Timothy Root is a practicing ophthalmologist and cataract surgeon in Daytona Beach, Florida. His books, video lectures, and training resources can be found at:

4 COMMENTS

  1. @Nick:

    I use steroids as staph marginal is more of an inflammatory reaction to bacteria along the eyelids than an infiltrative lesion. Thus, treatment is geared at decreasing the bacterial load (lid scrubs, antibiotic drops) AND decreasing the inflammatory response (steroids).

    Your gut reaction is a good one … as normally, steroids aren’t a good idea in the face of infection. I tend to watch larger lesions (like the one in this video) closely in case it turns into a full-blown ulcer. If so, then I stop the steroid, culture, and ramp up the antibiotic coverage.

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