Marginal corneal ulcer due to beta-streptococcus

H. B. Kim and H. B. Ostler

A 72-year-old woman with a low-grade nasolacrimal duct obstruction developed a hyperacute conjunctivitis caused by beta-hemolytic streptococci. This condition has been termed "conjunctivitis of Morax". An unusual feature consisting of a large, marginal furrow-like corneal ulcer was noted associated with a plastic iritis. The condition improved with the use of topical erythromycin, irrigation of the lacrimal sac with aqueous penicillin and oral penicillin. We believe that the marginal corneal ulcer was an actual infection of the corneal stroma resulting from the intense conjunctival chemosis trapping the exudate between the conjunctiva and the corneal epithelium, thus causing a breakdown of the corneal epithelium and allowing the organism to gain access to the stroma. Conjunctivitis of Morax can be clinically differentiated from a conjunctivitis associated with pneumococcal dacryocystitis and from the acute and hyperacute purulent conjunctivis due to infection with Neisseria.