Download A `marginal ulcer` - East Lancashire Eye Care

Marginal keratitis
What is a marginal ulcer?
A ‘marginal ulcer’ is a shallow ulcer on the surface of the cornea
What causes marginal ulcers?
Bacteria are trapped in the eyelids and some are naturally present on the surface of
the eyes. These bacteria produce toxins. The body’s immune system reacts to these
toxins to form an infiltrate on the cornea and then an ulcer
What are the predisposing factors?
Bacterial (Staphylococcal) blepharitis is the single most important factor.
What are the symptoms?
- Eye discomfort and foreign body sensation. At first your eye starts to feel a
little sore as though something may be in it
- Lacrimation - about 1-2 days later it may start to water
- Increasing pain, red eye, photophobia (sensitivity to bright light).
How is a diagnosis made?
Your eye doctor will examine your eyes under a special microscope – the slit lamp
after inserting eye drops. These drops contain a dye – fluorescein – which stains the
ulcer, if present.
What is the treatment?
There are two parts to the treatment:
 Treating the ulcer itself
 Prevention of more ulcers
You are usually given a combination of steroid and antibiotic drops to put in your
eye/s. This stops the eye’s immune system from over-reacting and so allows the
ulcer to heal.
If your ulcer does not start to get better after 2 days treatment, and particularly
if it gets redder or more sore, you will have to return to the Emergency Eye
Department
Some people develop marginal ulcers quite frequently, perhaps every few months.
How do I prevent these ulcers?
You may be able to stop more ulcers developing, or at least make them less
frequent, by cleaning your eyelids regularly. The cleaning helps to reduce the
number of bacteria in the glands of the lid.
Regular eyelid hygiene:
Warmth: A warm facecloth over both eyelids will help soften the secretions and also
allow the oily secretions made by the meibomian gland to flow freely.
Massage: Massaging the eyelids immediately after applying the warm facecloth for
five to ten minutes helps push any secretions from the meibomian gland through
their openings. Massaging the eyelids should neither be too gentle nor too firm and
it is recommended that you massage with the eyes shut.
Clean: After warmth and massage the eyelids can be cleaned with a dilute solution
of baby shampoo and water. It is important to clean the eyelid margins with either
clean cotton bud or a cotton ball. It is important to clean off any crusts at the base of
the eyelashes. Some people recommend using baby shampoo and water, there are
also other commercially available preparations like “Blephrasol” which can be used
to clean the eyelid margins.
It is important that this routine – warmth, massage and clean - should be done
regularly until the symptoms have cleared. As blepharitis is a chronic condition the
symptoms can also recur and it is advised that lid hygiene be practised as part of
your daily routine to prevent any further flare ups.