Search Results (238)

Background/Objectives: Octenidine dihydrochloride (OCT-D) is a broad-spectrum antiseptic with high chemical stability, low toxicity, and no reported microbial resistance, making it a strong candidate for use on mucosal surfaces. Despite increasing interest in its potential ophthalmic applications, limited data exist regarding its cellular effects on ocular tissues. This study aimed to investigate the cytotoxic, apoptotic, inflammatory, and transcriptional responses induced by OCT-D in human conjunctival (IOBA-NHC) and retinal pigment epithelial (ARPE-19) cells. Methods: Cells were exposed to varying concentrations of OCT-D, and viability was assessed using the WST-1 assay to determine IC₅₀ and IC₅₀/2 values. These concentrations were subsequently used in molecular assays. Pro-inflammatory cytokines (IL-6, IL-1β, TNF-α, IFN-γ) were quantified by ELISA. Apoptotic activation was evaluated through caspase-3/7 activity assays. Gene expression analysis of apoptotic (Bax, Bcl-2), DNA damage-related (ATM, Rad51), and inflammatory markers was performed using RT-qPCR. Results: OCT-D induced a marked, dose-dependent reduction in cell viability in both cell lines, with ARPE-19 showing greater sensitivity. Caspase-3/7 activity increased significantly at IC₅₀ and IC₅₀/2, confirming intrinsic apoptotic activation. OCT-D markedly suppressed the release of key inflammatory cytokines and downregulated transcription of inflammatory genes. RT-qPCR revealed upregulation of pro-apoptotic and DNA damage-associated genes, demonstrating coordinated activation of apoptotic and genomic stress pathways. Conclusion: OCT-D triggers integrated cytotoxic, apoptotic, and immunomodulatory responses in conjunctival and retinal epithelial cells. While these findings provide important mechanistic insights into OCT-D’s cellular effects, further studies using primary cells, advanced 3D ocular models, and disease-relevant systems are required to support its potential translational use in ophthalmology. Full article

The aim of this study was to evaluate the performance and safety of T2769 (Thealoz^® Total), a preservative-free eye drop combining 0.15% sodium hyaluronate, 3% trehalose, and 2.45% N-acetylaspartyl-glutamate (NAAGA), in contact lens wearers with dry eye symptoms and discomfort. This prospective, single-arm investigation enrolled 34 adult contact lens wearers with Ocular Surface Disease Index (OSDI) scores ≥ 18 and Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8) scores ≥ 12. Patients instilled one drop of T2769 three to six times daily for 36 days. Performance assessments included CLDEQ-8, ocular discomfort and symptoms, OSDI, soothing sensation, and ocular signs. Safety assessments included adverse events (AEs), far BCVA, and ocular tolerance. CLDEQ-8 improved from the baseline at Day 36 (−12.6 ± 5.0; p < 0.001) and as early as D15, with similar improvements in ocular discomfort, OSDI, and total symptom score. Soothing sensation was judged important by 79.4% of patients at D36. Ocular surface staining, tear break-up time, and the Schirmer test improved at D15 and D36, while conjunctival hyperaemia improved in 82.4% of patients at D36. Two non-serious treatment-related AEs (photophobia and blurred vision) occurred in one patient. BCVA was unchanged, and tolerance was rated very satisfactory/satisfactory. In conclusion, T2769 was safe and effective for reducing contact lens-associated dry eyes and discomfort. Full article

Conjunctival inflammation assessment is fundamental for diagnosing and monitoring various ocular surface diseases. This review summarizes grading scales available for conjunctival inflammation, discussing both subjective and objective methodologies. Widely used clinical grading systems include slit-lamp findings classification scale, Mandell scale for conjunctival injection, McMonnies and Champman-Davies scale, CCLRU (Cornea and Contact Lens Research Unit) scale, Efron scale, and VBR (validated bulbar redness) scale. They provide standardized frameworks for assessing conjunctival hyperemia and inflammation severity. However, these subjective methods are limited by inter-observer variability and lack of precision in detecting subtle changes. Recent technological advances have introduced objective digital imaging systems and automated algorithms that may offer improved reproducibility and sensitivity. Novel approaches include the integration of artificial intelligence for automated assessment. The validation of these scales across diverse patient populations has demonstrated varying degrees of reliability and clinical utility. Current evidence suggests that while traditional subjective scales remain clinically relevant, objective measurement systems provide superior repeatability and may better serve research applications requiring precise quantification of inflammatory changes. This review summarizes current knowledge regarding conjunctival inflammation grading methodologies and provides insights into novel developments in the field. Full article

Background: Urban air pollution, particularly fine particulate matter (PM2.5 and PM10), poses health risks, including damage to the ocular surface. This pilot study (BIKE-EYE) aimed to assess ocular exposure to airborne pollutants during bicycle commuting and to evaluate particle presence in human tear fluid. Methods: Fifteen healthy volunteers wore portable sensors measuring PM2.5 and PM10 during daily bike commutes over six months. Exposure was calculated as time-weighted integrals over the ten days preceding an ophthalmologic exam assessing conjunctival hyperemia, epithelial damage, tear film quality, and meibomian gland function. Ocular symptoms were assessed via the Ocular Surface Disease Index (OSDI). Tear samples were analyzed using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS). Results: Higher pollutant exposure was significantly associated with conjunctival hyperemia and corneal epithelial damage, while temperature and humidity showed no effect. OSDI scores moderately correlated with PM levels. SEM/EDS analysis confirmed airborne particles in post-exposure tear samples, including carbonaceous material, aluminosilicates, iron, and sulfur compounds. Conclusions: Ocular surface alterations and conjunctival hyperemia were significantly associated with air pollution exposure, while subjective symptoms showed weaker trends. The detection of particulate matter in human tear fluid supports the use of the ocular surface as a sensitive, non-invasive tool for biomonitoring. These findings highlight its potential role in early warning systems for pollution-related health effects, with implications for public health surveillance and urban planning. Full article

Background and Objectives: Ankylosing spondylitis (AS) is a chronic inflammatory disorder frequently associated with acute anterior uveitis; however, it may also predispose individuals to dry eye disease. We aimed to evaluate dry eye in AS participants employing both conventional tests and conjunctival impression cytology (Nelson grading) to compare their sensitivity in detecting ocular surface changes. Materials and Methods: This prospective case–control study enrolled 24 patients with AS and 27 age- and sex-matched healthy controls. Dry eye was evaluated using the Schirmer I test (measuring tear production), fluorescein tear break-up time (BUT, assessing tear film stability), the Ocular Surface Disease Index (OSDI) questionnaire (evaluating symptoms), and conjunctival impression cytology (analyzing ocular surface changes). Intergroup differences were assessed using non-parametric statistical methods, and their correlations with clinical variables were examined. Results: Nelson conjunctival cytology scores were significantly higher in AS patients than control subjects (1.63 ± 0.92 vs. 0.74 ± 0.86; p = 0.001), indicating greater conjunctival goblet cell loss and squamous metaplasia. In contrast, Schirmer, BUT, and OSDI observations did not differ significantly between AS and control subjects (all p > 0.05). Within AS, the Nelson cytology grade did not correlate accompanied by tear test observations or disease activity indices, and symptom scores did not align accompanied by Schirmer or BUT values. Conclusions: AS patients demonstrated evidence of subclinical dry eye changes detectable by impression cytology even when standard tests were normal. Conjunctival cytology was more sensitive than Schirmer, BUT, or symptom assessment in identifying ocular surface involvement in AS. Integrating such ocular surface evaluation into AS management could allow earlier diagnosis of dry eye and prompt intervention to improve patient quality of life. Full article

Objective: To evaluate the efficacy of lid wipes and tear substitutes, in addition to standard postoperative treatment, in alleviating signs and symptoms of ocular surface disease (OSD) following cataract surgery. Methods: Retrospective study on patients who underwent cataract surgery and received either standard postoperative treatment (topical antibiotics, corticosteroids, and nonsteroidal anti-inflammatory drugs) or the same regimen supplemented with lid wipes and tear substitutes. Preoperatively and one month postoperatively, symptoms were evaluated using the 5-item Dry Eye Questionnaire (DEQ-5) and the Ocular Surface Disease Index (OSDI), while noninvasive keratograph break-up time (NIKBUT), tear meniscus height (TMH), conjunctival hyperemia, and infrared meibography were measured by the Oculus Keratograph. Results: A total of 63 patients (mean age 75.1 ± 6.3 years) were analyzed. Patients receiving standard treatment showed no significant changes in OSDI (+2 ± 32.7; p = 0.859) or DEQ-5 scores (+1.7 ± 5.4; p = 0.204). Conversely, those receiving the adjunct of lid wipes and tear substitutes demonstrated significant improvement in OSDI scores (−19.4 ± 15.9; p < 0.0001), a trend toward improvement in DEQ-5 scores (−1.9 ± 5.5; p = 0.059), and a reduction in the meibography score of the inferior eyelid (−0.24 ± 0.60; p = 0.023). Intergroup comparisons showed significantly greater improvements in both OSDI and DEQ-5 scores in patients receiving treatment for the ocular surface. Multivariate regression analysis confirmed the association between the use of wipes and tear substitutes and improvements in OSDI (p = 0.010) and DEQ-5 scores (p = 0.015). No significant postoperative changes in objective OSD parameters were observed in either group. Conclusions: The addition of lid wipes and tear substitutes to the standard postoperative regimen significantly improved patient-reported symptoms of ocular discomfort after cataract surgery, while no significant changes were observed in objective signs of ocular surface disease. These findings support the routine use of lid wipes and tear substitutes as an effective strategy for managing postoperative ocular surface discomfort. Full article

Human allogeneic umbilical cord blood serum stands out as a potent adjunct to conventional therapies for ocular surface disorders related to severe Dry Eye Disease. By expediting ocular surface regeneration and fostering epithelial integrity, umbilical cord blood serum not only enhances subjective patient experiences but also improves objective clinical indicators. This makes it particularly useful in patients with corneal ulcers through ocular surface regeneration and anti-inflammatory activity. This retrospective, interventional, non-randomized clinical study aims to explore the efficacy of allogenic umbilical cord blood serum in patients who had previously received other treatments unsuccessfully. This study was a retrospective, non-comparative, interventional clinical study involving 55 patients (35 females and 20 males) aged 18–82 years with severe Dry Eye Disease who were unresponsive to standard treatments. The study was conducted at Eye Center “G.B. Morgagni-DSV”, Catania, Italy. Patients were categorized based on the etiology of severe Dry Eye Disease into four groups: group I consisted of 26 patients with filamentary keratitis and corneal ulcers associated with rheumatologic diseases such as Sjogren’s syndrome and systemic sclerosis; group II comprised 15 patients with graft-versus-host disease; group III consisted of 10 patients with corneal neurotrophic ulcers; group IV included four patients with Steven–Johnson syndrome. Outcomes evaluated before and after treatment were OSDI (Ocular Surface Disease Index) and SANDE (Symptom Assessment in Dry Eye) Questionnaires, VAS (Visual Analog Scale), Slit-Lamp Examination, Esthesiometry, Lissamine Green Staining, NIBUT (Non-Invasive Break-Up Time) and BUT, Fluorescein Staining with Photography and Oxford Classification, Schirmer Test, Best-Corrected Visual Acuity (BCVA), Meibography. We observed a significant improvement in SANDE, VAS and OSDI questionnaires, Schirmer Test, BUT, BCVA, and Oxford classification after treatment with allogeneic cord blood serum eyedrops. Clinical variables, such as corneal inflammation, conjunctivalization, corneal neovascularization, or pain, were also considered individually. Nevertheless, pain and inflammation reduced markedly over time until completely healed in all cases. Our study highlights the remarkable efficacy of allogeneic cord blood serum eyedrops in patients with severe Dry Eye Disease who have shown absent or inadequate response to usual treatments for dry eye. This underscores the need for further comprehensive investigations in this field. Full article

Background: This study aimed to evaluate the effects of Trimix^® on the microvilli and glycocalyx of ocular conjunctival epithelial cells, assessing drug persistence on the cell surface and its interaction with the glycocalyx. Microvilli, vital indicators of cellular health, are altered in inflammatory or toxic conditions, making their restoration a key therapeutic target. Method: Building upon previous scanning electron microscopy work, this investigation utilized Transmission Electron Microscopy (TEM) to delve into the direct interaction between Trimix and the cell membrane, elucidating its role in cellular mechanisms. The research involved both an in vitro phase, examining the drug’s molecular arrangement, and an in vivo phase, treating three subjects (healthy, moderate inflammation, severe dry eye) for 30 days. Cytological samples were taken via impression cytology for TEM analysis to observe the drug’s long-term action and its influence on microvillar structures, glycocalyx, and vesicular transport. Results: We demonstrated that Trimix stimulated vesicular transport and promoted the formation of a rudimentary glycocalyx, significantly increasing its presence and the number of microvilli in treated patients across all inflammatory grades, even in severe dry eye. Conclusions: In conclusion, Trimix acts as an effective glycocalyx substitute, restoring the second mucosal system (SMS) and enabling distressed cells to resume essential exchange functions, offering a novel therapeutic approach for dry eye disease. Full article

Dry eye disease (DED) is a multifactorial ocular surface disorder that significantly affects vision and quality of life. While artificial tears are the standard first-line therapy, their effectiveness is limited by the complex pathophysiology of DED. This study evaluated DayDrop^® Triple Action, a novel formulation combining hyaluronic acid (HA), ectoine, and carboxymethylcellulose (CMC), designed to enhance tear film stability and ocular surface protection. Physicochemical and rheological properties were assessed, including viscosity, pseudoplasticity, and viscoelastic behaviour under dynamic conditions, along with ectoine release over 24 h. An in vitro allergic conjunctivitis model using conjunctival fibroblasts exposed to a pro-allergic cytokine cocktail was employed to examine immunomodulatory effects. DayDrop^® Triple Action demonstrated high viscosity with pronounced pseudoplasticity and stable viscoelasticity, supporting improved mucoadhesion. The formulation provided sustained ectoine release and exhibited a positive immunomodulatory effect, likely linked to ectoine’s preferential hydration mechanism, which stabilizes membranes and reduces inflammatory signalling. These findings suggest that DayDrop^® Triple Action integrates viscoelastic optimization, osmoprotection, and targeted anti-inflammatory action, offering a promising non-pharmacological strategy for managing DED and allergic ocular surface disorders. Full article

Ocular melanoma is a rare but clinically significant malignancy, primarily comprising uveal and conjunctival subtypes. Although sharing some histopathological features with cutaneous melanoma, these tumours are characterized by distinct molecular and biological profiles with direct implications for prognosis and treatment. Uveal melanoma is predominantly driven by mutations in GNAQ and GNA11, along with alterations in BAP1, SF3B1, and EIF1AX, which are key prognostic determinants. Conversely, conjunctival and eyelid melanoma exhibits greater molecular similarity to cutaneous melanoma, commonly involving BRAF, NRAS, NF1, and TERT promoter mutations. Despite progress in the molecular characterization of these entities, metastatic disease continues to confer a poor prognosis, particularly in uveal melanoma. Ongoing research into the molecular basis of ocular melanoma is essential to advance targeted therapies and improve clinical outcomes. The aim of this review is to provide a comprehensive overview of ocular melanoma, with a particular focus on the molecular biology underlying its clinical behaviour and emerging therapeutic opportunities. Full article

Glaucoma is traditionally defined as an ocular disease characterized by progressive retinal ganglion cell degeneration, in some cases with elevated intraocular pressure (IOP), and optic nerve damage. However, growing evidence indicates that glaucoma shares critical features with neurodegenerative disorders, including Alzheimer’s and Parkinson’s diseases. This study aimed to explore the systemic nature of primary open-angle glaucoma (POAG) by integrating visual function, cognitive performance, and transcriptomic profiling. We conducted a multidimensional assessment of POAG patients and age-matched controls, accounting for demographic factors. Structural parameters included retinal nerve fiber layer (RNFL) thickness, measured using optical coherence tomography (OCT), and visual field indices mean deviation (MD) and pattern standard deviation (PSD). Cognitive function was evaluated across multiple domains, encompassing visual memory, executive function, processing speed, and verbal fluency. Additionally, transcriptomic analysis was performed from conjunctival samples to identify differentially expressed genes (DEGs) and enriched pathways. POAG patients exhibited significant RNFL thinning, which correlated with both visual field loss and cognitive impairments, particularly in terms of visual memory and executive function. Transcriptomic profiling revealed a distinct gene expression signature in POAG, including upregulation of TTBK1 and CCN2 (CTGF), genes associated with tau phosphorylation and extracellular matrix remodeling. Functional enrichment analysis indicated the involvement of neurodegenerative pathways, such as glutamate signaling, calcium signaling, and cell adhesion. Our findings support the reclassification of glaucoma as a neurodegenerative disease with both ocular and cognitive manifestations. Furthermore, biomarkers such as TTBK1 and CCN2 may serve as potential targets for early detection and neuroprotective therapy. Full article

Dry eye disease (DED) is a prevalent condition characterized by ocular surface inflammation and pain. This study evaluated the long-term progression of DED by analyzing clinical and molecular status, considering the impact of chronic ocular pain. Patients with DED were evaluated at two visits (V1 and V2) separated by at least two years. Evaluations included validated symptom questionnaires alongside slit-lamp examination, corneal sensitivity testing, and sub-basal nerve plexus analysis. Basal tear samples were collected for multiplex quantification of 20 cytokines and substance P (SP), and conjunctival cells were obtained to analyze 25 genes and 12 microRNAs (miRNA). Based on the presence or absence of chronic ocular pain, patients were then divided into two groups. Patients improved in DED-related symptoms, with no changes observed in ocular surface signs. Corneal dendritic cell density decreased, along with epidermal growth factor (EGF), fractalkine, and monocyte chemoattractant protein (MCP-1) tear levels, whereas interleukin (IL)-10 and SP tear levels increased. Neurotrophic tyrosine kinase, receptor, type (NTRK)1 gene expression was significantly downregulated, especially in patients without chronic ocular pain. miR-665 expression decreased significantly in DED patients. Monitoring corneal dendritic cells, tear cytokines, and gene/miRNA expression offers promising tools for tracking DED progression. Distinguishing the presence of chronic ocular pain as a separate symptom is crucial to optimizing therapeutic strategies and DED progression. Full article

This comprehensive review examines the multifaceted interactions between influenza viruses and the ocular system, integrating viral pathogenesis, clinical manifestations, and vaccine-related considerations. Influenza A subtypes (H7, H1N1, H5N1) and influenza B viruses induce a spectrum of ocular complications, from mild conjunctivitis—predominantly associated with H7 avian strains—to sight-threatening disorders like uveal effusion syndrome, acute macular neuroretinopathy, and optic neuritis. Experimental evidence confirms viral replication in human corneal and retinal cells, with H7N7 demonstrating unique tropism for ocular tissues via NF-κB-mediated inflammatory pathways. Clinical cases highlight direct viral invasion and immune-mediated mechanisms, such as Vogt–Koyanagi–Harada disease exacerbation and retinal vasculitis. Rarely, influenza vaccination has been linked to oculorespiratory syndrome, uveitis, and demyelinating events, though large-scale epidemiological studies (e.g., WHO safety reports) confirm vaccines’ favorable risk–benefit profile, distinguishing true adverse events from temporal associations. This synthesis emphasizes the need for ophthalmologists to prioritize surveillance during influenza seasons, integrating diagnostic tools like conjunctival RT-PCR and optical coherence tomography. Future research should focus on defining viral receptor-binding mechanisms in ocular tissues and developing targeted therapies for severe retinopathies, while reinforcing vaccination as a cornerstone of public health despite rare ocular risks. Full article

We evaluated the clinical applications of artificial intelligence models in diagnosing corneal diseases, highlighting their performance metrics and clinical potential. A systematic search was conducted for several disease categories: keratoconus (KC), Fuch’s endothelial corneal dystrophy (FECD), infectious keratitis (IK), corneal neuropathy, dry eye disease (DED), and conjunctival diseases. Metrics such as sensitivity, specificity, accuracy, and area under the curve (AUC) were extracted. Across the diseases, convolutional neural networks and other deep learning models frequently achieved or exceeded established diagnostic benchmarks (AUC > 0.90; sensitivity/specificity > 0.85–0.90), with a particularly strong performance for KC and FECD when trained on consistent imaging modalities such as anterior segment optical coherence tomography (AS-OCT). Models for IK and conjunctival diseases showed promise but faced challenges in heterogeneous image quality and limited objective training criteria. DED and tear film models benefited from multimodal data yet lacked direct comparisons with expert clinicians. Despite high diagnostic precision, challenges from heterogeneous data, a lack of standardization in disease definitions, imaging acquisition, and model training remain. The broad implementation of artificial intelligence must address these limitations to improve eye care equity. Full article

Background and Clinical Significance: Ocular cicatricial pemphigoid (OCP) is a rare autoimmune disease affecting the conjunctiva and oral mucosa. Chronic inflammation causes conjunctival scarring, leading to symblepharon, trichiasis, corneal damage, and possible blindness. Diagnosis is clinical, supported by biopsy and immunofluorescence. Treatment includes systemic corticosteroids, immunosuppressants, and biologics in refractory cases. Case Presentation: A 64-year-old male presented with ocular irritation, trichiasis, and counting fingers (CF) visual acuity in the left eye. Slit-lamp examination revealed conjunctival inflammation, corneal epithelial defect, and symblepharon in the left eye. Biopsy confirmed ocular cicatricial pemphigoid (OCP). He was treated with topical steroids, cyclosporine, subconjunctival injections, and systemic corticosteroids, followed by surgery, which improved BCVA to 0.10 logMAR. Two years later, disease progression resulted in severe inflammation and visual decline in both eyes. Systemic azathioprine and corticosteroids achieved partial control. Due to insufficient response, rituximab therapy was initiated, leading to significant reduction in inflammation and stabilization of disease. Right eye BCVA improved to 0.16 logMAR; the left remained at CF. The patient continues to receive rituximab during exacerbations and is under regular follow-up. Conclusions: Early diagnosis and timely systemic treatment are essential in preventing vision loss in OCP. In refractory cases, biologic agents like rituximab may offer effective disease control. Full article