Staph marginal keratitis (Video)
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)
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good presentation
what causes this disease? Is it treatable? Is it catchy? Is it cronic?
Why use a steroid for a bacterial-based pathology?
It’s a hypersensitivity reaction to bacterial toxin.
@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.
I will learn a lot from you. Thanks.