Peripheral Corneal Inflam

1. PERIPHERAL CORNEAL INFLAMMATION
1. Marginal keratitis
2. Rosacea keratitis
3. Phlyctenulosis
4. Acute stromal keratitis

2. Marginal keratitis
Subepithelial infiltrate
separated by clear zone
Circumferential spread Bridging vascularization
followed by resolution
• Hypersensitivity reaction to Staph. exotoxins
• May be associated with Staph. blepharitis
• Unilateral, transient but recurrent
Progression
Treatment - short course of topical steroids

3. Rosacea keratitis
Peripheral inferior
vascularization
Subepithelial infiltration Thinning and perforation
if severe
• Affects 5% of patients with acne rosaeca
• Bilateral and chronic
Progression
Treatment - topical steroids and systemic tetracycline or doxycyline

4. Phlyctenulosis
• Small pinkish-white nodule
near limbus
• Usually transient and resolves
spontaneously
• Starts astride limbus
• Resolves spontaneously or extends
onto cornea
• Uncommon, unilateral - typically affects children
• Severe photophobia, lacrimation and blepharospasm
Conjunctival phlycten
Treatment - topical steroids
Corneal phlycten

5. Acute stromal keratitis
Superficial or mid-stromal infiltration Opacification and vascularization
• Uncommon, usually unilateral
• Associated with non-necrotizing scleritis
Progression
Treatment - topical steroids and systemic NSAIDs