This patient has a mild marginal keratitis. The condition is made worse by the fact that he is a “half blinker” and has dry eyes and Anterior Basement Membrane Dystrophy”. Meibomianitis is also a precipitating factor. Exotoxins from bacteria in the eyelids cause this 4:00 staining, inflammation, and protective layer breakdown. This patient was treated with anti-inflammatory and antibiotic.