This guideline last updated 09/05/2022 10:15:55

Differential diagnosis

• Contact lens-associated microbial keratitis
• Contact lens-associated corneal infiltrate
• Rosacea keratitis
• Mooren’s ulcer
• Peripheral ulcerative keratitis associated with rheumatoid arthritis or other systemic collagen vascular disease
• Corneal phlyctenulosis
• Terrien’s marginal degeneration
• Herpes simplex keratitis

Possible management by Optometrist

Treatment

• Treat infection with antibiotic
  • Ask if allergic to Chloramphenicol
  • If not, supply Chloramphenicol 1% eye ointment 3 times daily for a week
  • If allergic to Chloramphenicol, or pregnant, supply Fucidic acid 1% liquid gel twice a day for a week
• If no suspicion of herpes simplex keratitis, treat inflammation with
  • PoM Prednisolone sodium phosphate 0.5% 2 times daily for a week
• Ask patient to return in one week for review, or sooner if symptoms worsen
  • Re-examine the patient
  • If healed: Discharge
• If not healed, phone ophthalmology department to arrange an urgent appointment

Advice

• Sunglasses to ease photophobia
• Refer to local Pharmacist for analgesia for pain relief (Paracetamol or Ibuprofen; dose depends on age)
• Marginal keratitis is a self-limiting condition which may recur
• Offer to review patient, if symptoms recur
• Regular lid hygiene for associated blepharitis will help limit recurrence

Management Category

• Management to resolution
• Refer to ophthalmologist if:
• Anterior chamber cells present
• Contact lens wearer
• Children should always be referred

Possible management by Ophthalmologist

• As above