For this reason the use of topical corticosteroid on a unilateral red eye in which the diagnosis is in doubt is absolutely contraindicated. Acute red eyes in which close inspection of the cornea reveals the presence of a white spot may represent purulent infiltration of the corneal tissue or microbial keratitis. Such cases are potentially associated with severe visual loss. The presence of a white infiltrate close to the corneal periphery in association with localised or generalised conjunctival inflammation is most likely to represent a marginal keratitis. The history given is one of pain and ocular discomfort sometimes described as a foreign body sensation.
Visual acuity is usually normal.
This condition is an inflammatory response commonly due to sensitivity to staphylococcal exo-toxin. First line management would include topical chloramphenicol or neomycin combined with a low dose of corticosteroids if the degree of confidence to exclude possible herpetic keratitis is obtained. Certainly such cases who fail to respond to treatment within twenty four hours should be referred as the diagnosis may be in doubt. Normally one would expect a rapid resolution of symptoms. Where There is no Corneal Defect Cases of acute red eye in which no epithelial or corneal defect is identified on inspection must be examined carefully for evidence of involvement of internal structures.