A 40-year-old man with chronic crusted anterior blepharitis develops a 1.5 mm whitish infiltrate at the temporal limbus, separated from the limbus itself by a clear interval of intact cornea, with faint overlying fluorescein staining and moderate circumcorneal injection. Which management is most appropriate?
- A Hourly fortified vancomycin and ceftazidime drops
- B Oral fluconazole for three weeks
- C Topical antibiotic combined with a weak topical corticosteroid, together with lid hygiene ✓
- D Cyanoacrylate tissue adhesive application
Correct answer: C. Topical antibiotic combined with a weak topical corticosteroid, together with lid hygiene
Explanation
A marginal infiltrate separated from the limbus by a clear zone in a patient with staphylococcal blepharitis is a catarrhal (marginal) ulcer, driven by hypersensitivity to staphylococcal exotoxins rather than by microbial invasion of the cornea. It responds to an antibiotic-steroid combination plus lid hygiene. Fortified hourly antibiotics are reserved for true infective bacterial ulcers, making option A the tempting wrong answer.
Reference: Khurana, Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.