Search Results (32)

Background/Objectives: Artificial intelligence (AI), including large language models, chatbots, machine-learning systems, and hybrid tools, is increasingly used to support patient-facing eye-care communication. This systematic review evaluated the accuracy and effectiveness of AI-powered systems used for patient counseling, education, communication, referral/follow-up, and management support in optometry and related eye-care settings. Methods: A systematic review was conducted according to a predefined protocol and PRISMA 2020 reporting principles. Searches covered studies published from January 2020 to 31 May 2026 in PubMed, Embase, Web of Science, Cochrane Library, and IEEE Xplore. Eligible studies were original primary studies evaluating AI-supported tools for patient-facing counseling, education, question answering, treatment or medication guidance, triage, referral, follow-up, screening linked to management, or clinical decision support. Methodological quality was appraised using relevant JBI critical appraisal tools. Results: Thirty-nine studies were included in the qualitative synthesis. JBI appraisal indicated heterogeneous study designs and reporting quality, with common limitations related to simulated prompts or AI-output evaluations, variable comparators, and inconsistent outcome reporting. Evidence was dominated by patient-facing large language models and chatbot-based tools used for patient education, question answering, readability improvement, glaucoma and myopia counseling, diabetic retinopathy referral/follow-up, cataract education, oculoplastic and retinal-condition questions, and multilingual educational support. Study designs, AI models, prompting approaches, comparators, clinical topics, and outcome definitions varied widely, supporting narrative synthesis rather than quantitative pooling. Conclusions: AI-powered systems show potential as supervised adjunctive tools for eye-care counseling, education, and management-related communication. However, evidence remains heterogeneous and dependent on simulated prompts, AI-generated outputs, and model-based evaluations. Future research should prioritize standardized evaluation, real-patient validation, safety monitoring, readability control, and patient-centered outcomes before routine implementation in optometry and broader eye-care practice across diverse clinical settings. Full article

Background: Lateral eye movements are part of natural ocular motility, and their effect on tear film behavior is largely unknown because they are usually not evaluated during tear film examinations, where patients are required to look straight ahead. This study aimed to determine what happens to the tear film during lateral eye movements in the absence of blinking. Methods: Tear film dynamics during a sequence of open-eye lateral gaze maneuvers were recorded using an infrared camera system (TearView). Results: The study included 15 healthy participants (5 female; median age 26) who had no ocular surface-related complaints. It was observed that lateral eye movements exposed new ocular surface areas not previously covered by the tear film. The tear film margins reacted to lateral eye movements by spreading towards the newly uncovered ocular surface areas, thereby recoating them. This response was asymmetrical, with a tear reservoir in the lacus lacrimalis of the medial canthus providing additional tear film spread only during ocular abduction. Conclusions: These findings expand our understanding of tear film physiology beyond static gaze. They might also bear implications for dry eye disease and oculoplastic surgical techniques affecting the medial canthus. Full article

Background: Eyelid malignancies require accurate intraoperative margin control to achieve complete tumor excision while preserving the functional and aesthetic integrity of the periocular region. Mohs micrographic surgery (MMS) is widely regarded as the reference standard for margin-controlled excision, whereas frozen section–controlled excision (FSC) represents a reliable and widely used alternative in oculoplastic practice. In parallel, several emerging imaging technologies are being investigated to improve real-time tumor detection and surgical precision. Methods: A narrative review of the literature was conducted to summarize current evidence on intraoperative margin control in eyelid tumor surgery. The review focused on established surgical techniques, including MMS and FSC, as well as emerging imaging modalities such as fluorescence confocal microscopy, reflectance confocal microscopy, optical coherence tomography, line-field confocal optical coherence tomography, photoacoustic imaging, and artificial intelligence (AI)-assisted analysis. Results: MMS provides complete circumferential peripheral and deep margin assessment and remains the benchmark for high-risk, recurrent, and poorly defined periocular tumors, particularly basal cell carcinoma. FSC offers favorable oncologic outcomes, allows immediate reconstruction, and remains an effective option when MMS is not available. Emerging imaging modalities have shown promising diagnostic performance for tumor detection, presurgical mapping, and intraoperative support, particularly in basal cell carcinoma, although evidence in periocular tumors remains limited for most techniques. AI-assisted approaches have also demonstrated high accuracy in the interpretation of frozen sections and optical imaging data, suggesting potential to improve workflow efficiency and diagnostic consistency. Conclusions: MMS and FSC remain the current standards for intraoperative margin control in eyelid tumor surgery. Emerging imaging technologies and AI-based tools may further enhance surgical precision and tissue preservation, but most remain investigational in the periocular setting. Further prospective studies are needed to validate their clinical utility, define standardized workflows, and clarify their role alongside established histopathologic techniques. Full article

Eyelid anomalies represent a relevant cause of corneal injury, including epithelial instability and recurrent erosions up to progressive stromal thinning, corneal melt, and, in severe cases, perforation leading to permanent visual impairment. Correction of eyelid dysfunction is the first step in managing these lesions. However, corneal damage may persist or progress despite adequate eyelid treatment. Therefore, a corneal surgical approach is necessary to preserve ocular surface integrity and visual function. This review synthesizes literature published between 2008 and 2025 on corneal complications secondary to eyelid anomalies and postoperative eyelid procedures. We analyzed the mechanisms of eyelid-induced corneal injury, indications for surgical treatment, and corneal surgical strategies, from surface-stabilizing techniques to tectonic interventions. Entropion and ectropion are the most common eyelid abnormalities associated with mechanical trauma and exposure-related corneal disease. Although definitive eyelid correction is necessary for corneal recovery, persistent epithelial defects, stromal thinning, corneal melt, and perforation frequently require corneal surgical management. Surface-stabilizing procedures, such as amniotic membrane transplantation, are effective in early disease stages, whereas progressive stromal defects necessitate tectonic approaches such as lamellar patch grafting or therapeutic keratoplasty. Interventions aimed at visual rehabilitation should be postponed until sustained ocular surface stability has been achieved. Effective management of eyelid-related corneal damage requires both eyelid surgical correction and corneal management. Close collaboration between corneal and oculoplastic surgeons helps achieving good anatomical outcomes and long-term ocular surface stability. Full article

Background: Upper eyelid blepharoplasty is one of the most common aesthetic surgeries performed worldwide. The procedure consists of removing excess skin with or without muscle and/or fat from the upper eyelid by a transcutaneous approach and placement of a supratarsal crease. The surgery is performed in a cosmetically sensitive area and every attempt to avoid poor scar formation should be made. Methods: This review presents a conspectus of the existing medical literature regarding scar-avoiding strategies in upper blepharoplasty with the aim of contributing to the reduction in postoperative scar formation. The Medline, Embase, and Cochrane databases were searched on 2 September 2025. Results: The search yielded a total of 562 records, and, following screening, eleven publications were included. Conclusions: A systematic approach to pre-, intra-, and postoperative measures to minimize scarring are presented. There is a need to standardize scar assessment and reporting to facilitate inter-study comparison of effects, as well as prospective, randomized studies comparing suture materials and techniques. Full article

Artificial intelligence (AI) and augmented intelligence have significant potential in oculoplastics, offering tools for diagnosis, treatment recommendations, and administrative efficiency. This article discusses current and potential applications of AI in ptosis, eyelid and conjunctival cancer, thyroid-associated orbitopathy (TAO), giant cell arteritis (GCA), and orbital fractures. AI-based programs can assist in screening, predicting surgical outcomes, and improving patient care through data-driven decisions. Privacy concerns, particularly with the use of facial and ocular photographs, require robust solutions, including blockchain, federated learning and steganography. Large generalizable datasets with adequate validation are crucial for future AI development. While AI can assist in clinical decision-making and administrative tasks, physician oversight remains critical to prevent potential errors. Large language models like ChatGPT also have the potential to counsel patients, although further validation is needed to ensure accuracy and patient safety. Ultimately, AI should be regarded as an augmentative tool that supports, rather than replaces, physician expertise in oculoplastic care. Full article

There is growing interest in the application of Rho-associated protein kinase (ROCK) inhibitors (ROCKI) to the treatment of corneal diseases. ROCK is a key regulator of several cellular processes in the cornea, including cytoskeletal organization, cell proliferation, migration, inflammation, and wound healing. ROCKI, such as ripasudil and netarsudil, enhances endothelial cell migration, and promotes repair in conditions characterized by endothelial dysfunction. These agents also exert anti-inflammatory, anti-angiogenic, and anti-fibrotic effects for wound healing. As such, ROCKI demonstrate promise as therapeutic options for conditions such as Fuchs’ endothelial corneal dystrophy, pseudophakic bullous keratopathy, and iridocorneal endothelial syndrome. Emerging data further supports ROCKI’s potential in managing corneal neovascularization and supporting recovery following cataract surgery and keratoplasty, reducing the need for donor tissue. This narrative review provides a comprehensive evaluation of ROCKI’s mechanism of action, pharmacological properties, safety profile, applications in corneal disease management, emerging clinical trials, and novel approaches. We emphasize both preclinical and clinical findings, highlight existing evidence gaps, and outline future research priorities. Full article

This study evaluates a novel high-density polyethylene (HDPE) browlift peg for brow fixation in endoscopic forehead lifting, assessing its safety, effectiveness, and aesthetic outcomes while contextualizing its use through a narrative review of existing techniques. Twenty-nine consecutive female patients underwent bilateral endoscopic brow lifts using a custom-shaped HDPE peg inserted into the frontal bone via a small paramedian incision. Outcomes included postoperative brow symmetry, defined as ≤2 mm asymmetry, and documentation of complications. The mean patient age was 62.1 years, with an average follow-up of 12.3 months. All patients achieved symmetric brow positioning within 2 mm. No cases of implant extrusion, wound dehiscence, or permanent nerve injury occurred. Minor complications included one case each of transient paresthesia, localized incision infection not involving the implant, and a palpable implant removed in-office under local anesthesia. A parallel narrative review highlighted common limitations in brow fixation strategies—namely, implant palpability, risk of relapse, cost, and invasiveness. These findings suggest that the HDPE peg is a safe, customizable, and cost-effective alternative for brow fixation, offering durable aesthetic results with minimal complications and potential value in aesthetic and oculoplastic surgery. Full article

This study aimed to comprehensively review surgical interventions for ocular surface diseases (OSDs), including dry eye syndrome (DES), exposure keratopathy, Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and ocular graft versus host disease (oGVHD), and to highlight the indications, contraindications, outcomes, and complications of various oculoplastic procedures used in their management. A narrative review was performed based on expert-guided selection of relevant studies retrieved from PubMed, Scopus, and Web of Science. Relevant keywords included “ocular surface disease”, “dry eye syndrome”, “exposure keratopathy”, “thyroid eye disease (TED)”, “neurotrophic keratopathy (NK)”, “Stevens-Johnson syndrome”, “toxic epidermal necrolysis”, “punctal occlusion”, “tarsorrhaphy”, “botulinum toxin”, “eyelid loading”, “retractor weakening”, “corneal neurotization (CN)”, “amniotic membrane transplantation (AMT)”, “conjunctival flap”, “ocular graft versus host disease”, and “salivary gland transplantation (SGT)”. Studies addressing surgical approaches for OSDs were included. In conclusion, surgical options for OSDs offer significant benefits when non-invasive treatments fail. Surgical techniques such as punctal occlusion, eyelid fissure narrowing, AMT, and conjunctival flap procedures help stabilize the ocular surface and alleviate symptoms. Advanced methods like CN and SGT target the underlying pathology in refractory cases such as oGVHD. The outcomes vary depending on the disease severity and surgical approach. Each procedure carries specific risks and requires individualized patient selection. Therefore, a tailored approach based on clinical condition, anatomical involvement, and patient factors is essential to achieve optimal results. Ongoing innovations in reconstructive surgery and regenerative medicine are expected to further improve outcomes for patients with OSDs. Full article

Diquafosol sodium is a purinergic P2Y₂ receptor agonist that is garnering much interest for its potential therapeutic benefits in ocular surface management. This review provides a comprehensive analysis of diquafosol’s pharmacology, clinical effectiveness, and role in the evolving landscape of ocular surface management. Future research should focus on optimising formulations, treatment duration, and exploring potential combination therapies to maximise therapeutic outcomes. By targeting underlying pathophysiological mechanisms, diquafosol represents a significant advancement in ocular surface management and a valuable addition to existing therapies. Full article

Background: This study introduces a novel surgical approach, the Marginal Approach for Releasing the lid with Closure Handling technique (MARCH technique), a single-step sparing tissue technique, for the reconstruction of medium to large full-thickness lower eyelid defects and its outcomes. Methods: The research considers a single-centre case series with a description of the MARCH technique. Patients with a full-thickness medium to large lower eyelid defect underwent this technique, which combines inferior cantholysis, splitting of lamellae and island or advancement flaps. Demographic data, lid defect size, histology and postoperative outcomes were collected. Results: The surgical procedure was performed in fifteen patients (nine males and six females). The mean age was 73.9 years (range 48–95 years old). Local anaesthesia was used in 86.7% of cases. The mean defect size was 68.7% (range 50% to 79%) of the lid length. All patients presented good results with no significant complications. Conclusions: The MARCH technique seems to be an excellent first-line approach in reconstructing medium to large full-thickness lower eyelid defects. Its single-step approach, tissue-sparing and minimally aggressive nature and ability to potentially guide eyelash positioning and restore the lacrimal system with a more anatomical position make it a promising option. Enrolling more patients and a longer follow-up would provide a better assessment. Full article

Background: Ectropion is a common eyelid problem and is defined as eversion of the eyelid margin and typically involves the lower eyelid. The main acquired causes of ectropion include involutional, cicatricial, paralytic, and mechanical. A severe manifestation of ectropion is tarsal ectropion, where much of the tarsal conjunctiva is visible, often with keratinization of the conjunctiva. causes. Common techniques for ectropion repair include horizontal tightening of the lid with lateral tarsal strip or Bick procedure, lateral tarsorraphy, inverting sutures and the sub-orbicularis oculi fat lift. However, all surgical techniques are prone to ectropion recurrence. We review the techniques for ectropion repair and describe a novel adjunctive technique called the superotemporal skin transposition (STS), which is well suited for patients with recurrent or tarsal ectropion. Methods: The STS is combined with a lateral tarsal strip or Bick procedure. For the STS, all of the anterior lamellae of the lateral lower lid is retained. The posterior lamellae is sutured to the lateral orbital tubercle. A triangular bed of skin is excised superotemporally, and the lower lid anterior lamellae is transposed and secured with multiple sutures. The STS can be combined with inverting sutures, or skin graft for cicatricial cases. Results: We used the STS with Bick procedure and optional inverting sutures on 23 patients, 4 of whom required bilateral ectropion repair. At 1–6 month followup all patients achieved satisfactory outcomes with a well-positioned eyelid and improved symptoms. The STS had more lateral cutaneous scarring than with a Bick procedure alone, but patients did not find this objectionable. No reoperations were required. Conclusion: The STS is a straightforward and useful adjunct for patients with severe, recurrent or tarsal ectropion. Further studies are needed to determine the long-term efficacy of this technique. Full article

As the face ages, the skin, fat, muscle, and fascia descend, and the underlying bone, cartilage, and teeth may lose mass. Oculofacial aging is a multifactorial process that is influenced by genetic, environmental, and lifestyle factors. This review summarizes the patterns of oculofacial aging that are observed across populations, including variations in periorbital hollowing, eyelid ptosis, and skin elasticity. Evidence indicates significant variability in aging patterns between sex- and race-based subgroups. Nonetheless, there remains a paucity of research on the progression of aging in some under-studied demographic groups. Signs of oculofacial aging often become apparent to patients well before these changes reach full maturity in later years, leading many to seek early esthetic interventions. Others may present with more advanced signs of aging, motivating a diverse range of therapeutic options. We discuss minimally invasive esthetic interventions to mitigate the signs of aging, which may include botulinum toxin injections, dermal fillers, applied energy-based treatments (e.g., lasers), and emerging techniques such as micro-focused ultrasound and platelet-rich plasma therapies. We review evidence on outcomes related to patient satisfaction and quality of life following esthetic interventions for oculofacial aging. Finally, we outline ethical considerations and challenges faced with the delivery of esthetic surgery, including treatment complications and the influence of social media. This review provides a comprehensive overview of oculofacial aging patterns, its management, and important considerations for the provision of esthetic oculofacial treatment. Full article

OBJECTIVES: To describe our experience with a new high-density porous polyethylene orbital implant post-enucleation and evisceration and comment on their performance and safety. METHODS: Patients with an indication of enucleation or evisceration with orbital implantation were included in a prospective study. All patients were implanted with OCULFIT orbital implants (AJL Ophthalmic S.A.) and followed up over 12 months. Anatomical and functional parameters, motility, and aesthetic appearance were evaluated. Patient satisfaction on a scale of 0 (very bad) to 5 (excellent), complications and success rates were reported. RESULTS: Overall, 16 enucleated and 17 eviscerated eyes were analyzed. Orbital implant motility was good for 93.8% and 100% of enucleated and eviscerated patients, respectively. No shortened fornixes were found after external prosthesis placement, and palpebral fissure, orbital volume, and lower eyelid laxity were symmetric with the contralateral eye for the vast majority. The aesthetic appearance was good for 87.5% and 100% of enucleated and eviscerated patients at the last visit with no differences between groups. Excellent satisfaction was reported for 100% and 94.1% of enucleated and eviscerated patients. Anatomical and functional success rates were 78.8% and 81.8%, respectively. No exposure, infection or complications related to surgery were reported during the follow-up. CONCLUSIONS: After 1 year of follow-up, OCULFIT orbital implants provide excellent patient satisfaction and performance in terms of motility and symmetry with the contralateral eye after external prosthesis placement with no complications related to the surgical procedure. No differences between enucleated and eviscerated eyes were found, and aesthetic results were remarkable for both groups. Conclusions should be interpreted with caution due to the small sample size. Full article

Background: Malignant eyelid tumours present a considerable challenge in the field of ophthalmic oncology, necessitating a combination of precision oncological care and meticulous reconstruction to ensure the preservation of eyelid functionality and the maintenance of facial aesthetics. Method: This study presents a review of the outcomes of 167 patients who underwent eyelid reconstruction following the excision of primary non-melanocytic malignant tumours. The choice of reconstruction technique was dependent on a number of factors, including the stage of the tumour, its location, and the characteristics of the patient. The most commonly used techniques included regional flaps, local flaps, and skin grafts. The most frequently employed reconstruction techniques were forehead flaps (59 cases), simple excisions (38 cases), and Mustarde cheek flaps (16 cases). Result: The postoperative complications, including ectropion, epiphora, and flap necrosis, were recorded. However, no significant correlation was found between the risk of complications and either the location of the tumour or the reconstruction method employed. Despite the complexity of medial canthal and lower eyelid reconstruction, satisfactory aesthetic and functional outcomes were generally achieved. Conclusions: This study emphasises the importance of individualised surgical planning, highlighting the advantages and limitations of various techniques to optimise both the functional and aesthetic results. Full article