Good Hope, Heartlands, and Solihull Eye Clinics

Peripheral Ulcerative Keratitis / Marginal Corneal Ulcers

David Kinshuck



What is peripheral ulcerative keratitis?

A 'marginal ulcer' is a shallow 
            ulcer on the surface of the cornea.

the cornea 

A small ulcer forms on the front part of the eye, the cornea. The cornea is the clear 'window' of the eye'.

An 'ulcer' is a shallow crater, a bit like a crater on the surface of the moon. A doctor or nurse can see the ulcer by using a slit lamp, a type of microscope, used in the eye clinic.


a marginal ulcer: the eye is red just near the ulcer

'peripheral ulcerative keratitis' is a shallow ulcer on the surface of the cornea, on the edge of the cornea.
The eye is red just near the ulcer.
The ulcer appears green when the doctor or nurse places a fluorescent dye drop in the eye.

marginal ulcer, side view

a side view










What is happening?

The ulcer forms as part of the body's reaction to a mild bacterial infection. Some bacteria are trapped in the eyelids, and some are naturally present on the surface of everyone's eyes. The bacteria may invade the surface of the cornea, and your body's immune system reacts to the bacteria to make the ulcer. When the body 'overreacts' an ulcer forms.

Peripheral ulcerative keratitis in a contact lens wearer can be topical steroids.


How does it feel?

At first the eye starts to feel a little sore, as though something may be in it, and a little bit achy. About 1-2 days later it may start to water and be painful and red. Bright lights become painful, and your eye may become sticky and difficult to open in the morning.  'Pain, discomfort, photophobia.'



First, without systemic disease: these are discussed on this page

  • marginal
  • Rosacea
  • Phlyctenulosis

Systemic/more serious, not discussed on this page

  • Type 1 older no systemic problems
  • Type 2 younger
    • helminthic infection
    • hepatitis C, CBC
    • Much more aggressive ..larger deeper
    • anca other antibodies
    • Rheumatoid with PUK

Treat these (which may be termed Moorens ulcers) with systemic steroids, or other immunosuppressive. Conjunctival recession may help. Some eyes are inflamed, others look quiet



There are two parts to the treatment:

Treatment for the ulcer itself

Treatment is usually given steroid drops to put in the eye. These stop the eye's immune system overreacting and so allows the ulcer to heal. The steroid drops, such as prednisolone or dexamethasone, generally have no side effects for the short time they are needed (1-3 weeks). The ulcer usually gets a little better in a day, and completely better in a week. Sometimes an antibiotic drop is needed such as chloramphenicol to stop a more serious infection of the cornea.

  • Marginal ulcer in contact lens wearer can be topical steroids.
  • Occasionally herpes simplex present and this can be identified with a PCR scrape.
  • If there is a lot of melting and infiltrate, a combination of antibiotics and steroids may be needed.

What to expect

A typical attack will last a week without treatment, sometimes getting better without drops. With drops the drops above your eye will feel a lot better the next day, nearly recovered in 3-4 days, and nearly back to normal after a week.

If there is no improvement in 2 days, you may have a different type of ulcer. You should certainly seek advice from an ophthalmologist if your eye gets worse not better.


To prevent a cycle of recurrences

Bacteria in the glands of the eyelids help to cause these ulcers. Some people develop marginal ulcers quite frequently, perhaps every few months.


Lid cleaning

Cleaning the eyelids regularly may be stop more ulcers developing, or at least make them less frequent . The cleaning helps to reduce the number of bacteria in the glands of the lid.

  • warm compresses
  • clean lids with cotton bud
  • antibiotic cream occasionally helps
  • antibiotic tablets if attacks frequent
  • doxycycline (long term; avoid lot of sunlight as it sensitises the skin to sunlight. 'photosensitivity')
  • or azithromycin (3 days)
  • a healthy diet as for Blepharitis see NHS Direct

Warm compresses

  • Use clean face cloth soaked in warm water, as hot as your eyelids can stand.
  • Bathe your eye (closed) for 5-10 minutes. Re-warm the cloth if it gets cold. This makes the debris easier to remove, as below.

Clean with a cotton bud

Gently clean with a cotton bud, looking in mirror

Gently clean with a cotton bud, looking in mirror

Clean the edge of the eyelids (the eyelash edge) with a wet cotton bud. Gently scrape off the debris moving the bud side to side. Use warm sterile water, that is boiled water allowed to cool but still warm. (Warm tap water is usually quite safe.)

Looking in a mirror, pull the lower eyelid down with the index finger of one hand, and gently but firmly wipe the bud along the edge of the lid to scrape the debris off. With your chin up try the same on the upper lid, but this is harder.



Antibiotic cream

An antibiotic cream may help (as below); this can be squirted into the eye, or squirted onto your finger, and you can then spread it over the eyelids. Alternatively, apply the ointment with the cotton bud onto the eyelid. If you develop marginal ulcers every month for several months, antibiotic treatment may be helpful. An antibiotic cream may help, such as Fucithalmic twice daily for one or more months, depending on how frequent your ulcers are.


Antibiotic tablets

If this does not work, and your ulcers are very troublesome, tablets may help: providing you are not pregnant and are otherwise well ... ask your doctor first. Doxycycline 50-100mg a day is often effective, for 3 months. Generally you should have seen an ophthalmologist at least a couple of times with ulcers before considering tablets. Alternatively azithromycin (3 days).

Occasionally there may be recurrences even with these 'preventative' measures, but gradually the episodes become fewer with longer between.


Infected marginal ulcers

  • Corneal ulcers commoner in rheumatoid
  • Staph aureus..50% none carriers, 20% persistence
  • Topical fucithalimia, vanco, teicoplanin
  • Treat infection no steroid for first week
  • Mupiricin and chlorhexidine baths daily for a week and mupiricin..up nose, prontoderm body spray (same protocol as MRSA)



Leaflet download

marginal corneal ulcer leaflet, publisher

If you are a health professional and want to have a leaflet to give to give to patients, instead of this web page, see 180k Adobe.

Alternatively, this is a Microsoft Publisher document