Ms Melvin observed that within Grampian's Eye Health Network, acute conditions, such as foreign bodies, uveitis, herpes simplex epithelial keratitis and marginal keratitis
, are solely managed by primary care optometrists, which differs from the rest of the country.
In our case, combining simultaneous noncentered PACKCXL with centered tectonic penetrating keratoplasty was carried out to treat the fungal marginal keratitis with corneal perforation, in which regular penetrating keratoplasty alone would leave fungal elements in the receptor corneal tissue, which would predispose to infection of the graft.
(ii) Combining simultaneous noncentered PACK-CXL with centered penetrating keratoplasty appears to be a safe and effective way of treating patients with fungal marginal keratitis with corneal perforation.
Marginal furrow degeneration, Dellen, collagen vascular diseases, sclerokeratitis, staphylococcal marginal keratitis
, pellucid marginal degeneration etc have been proposed as differential diagnosis.
Blepharitis is a common cause of this condition (marginal keratitis
of episodes Amaurosis fugax 1 Angle closure glaucoma 1 Anterior uveitis/iritis 1 Corneal abrasion 1 Corneal ulcer 1 Herpes keratitis 3 Malignant BCC/SCC/SGC 1 Marginal keratitis
2 Septal cellulitis/peri-orbital 3 Retinal tear/hole 5 Scleritis 3 Viral conjunctivitis 1 Wet AMD 1 Figure 1 Appropriateness of optometrist referral (was the referral appropriate based on outcome of assessment?) Number of patient episodes No 13% Yes 87% Note: Table made from bar graph.
In the case of marginal keratitis
, this is always treated more conservatively with polyfax qid; steroids are not considered necessary in all cases.
Long-term and/or extended wear of contact lenses may result in marginal keratitis, which is a mild-to-moderate inflammatory response that is often refractory to management.
Marginal keratitis in the absence of contact lens wear
An infectious blepharitis, if not managed properly, can easily lead to development of blepharoconjunctivitis whereby the bacteria infect the mucous membranes of the conjunctiva as well as the eyelid margins, and can also be associated with a marginal keratitis (see next article in this series).
Which of the following bacteria would be the MOST likely cause of a severe conjunctivitis with marginal keratitis?
* Marginal keratitis
. The cause is a hypersensitivity reaction to staphylococcal exotoxins.