Search Results (513)

Background/Objectives: Allergic conjunctivitis (AC) is a frequent inflammatory ocular surface disease that significantly affects quality of life, particularly in children. Current treatments mainly provide temporary symptom relief and often require prolonged use. Bacterial suspensions have emerged as potential immunomodulatory treatments for other allergies but have yet to be completely explored for ocular allergies. Our study’s objective was to describe the clinical, ophthalmological, and quality-of-life changes in patients with AC treated with a bacterial suspension (BS) as complementary therapy. Methods: A before-and-after open, non-controlled clinical study was conducted in five children aged 7 to 9 years with a diagnosis of moderate-to-severe persistent allergic conjunctivitis and negative skin prick test results. Clinical ocular signs and symptoms, quality of life, and changes in CD19⁺IL-10⁺ cells were assessed. Results: After 90 days of BS treatment, reductions in allergic symptoms, including itching, light sensitivity, and burning, were observed, along with a marked reduction in ocular inflammation. An evaluation of quality-of-life revealed improvements across all domains and an increase in CD19⁺IL-10⁺ cells. Conclusions: BS therapy demonstrated favorable clinical and immune-modulatory effects in children with AC, supporting its potential as a promising complementary therapeutic option. Full article

Objectives: This study aimed to determine whether eccentric gaze produces a regional, gaze-aligned redistribution of tear-film quality that is more apparent in spatial analysis than in whole-map summary measures. Methods: This was a secondary analysis of a previously acquired Medmont Meridia composite-topography dataset from 38 healthy participants, using only the Medmont data. Tear-film quality maps from the ahead, right, left, up, and down gaze were interpolated onto a common grid, aligned to a shared reference frame, and analysed using descriptive global measures, regional spatial mapping, and a threshold-based directional sector analysis. The threshold analysis used an operational cut-off of 0.35 to classify good-quality pixels, with lower values indicating better tear-film quality. Robustness was assessed by repeating the same analysis across nearby cut-offs from 0.30 to 0.40. As Placido-based topography measures reflection from the tear layer rather than the ocular surface itself, and as ocular rotation changes lid position and exposed ocular surface area, aligned comparisons were interpreted as comparisons of the exposed tear-film pattern rather than exact point-for-point anatomical tracking. Results: Global tear-film summary measures showed only modest variation with gaze direction, whereas spatial mapping revealed systematic regional redistribution of tear-film quality across eccentric gaze conditions. At the 0.35 operational threshold, the gaze-aligned good-pixel index was positive for right gaze (0.297 ± 0.200), left gaze (0.213 ± 0.174), up gaze (0.204 ± 0.219), and down gaze (0.308 ± 0.260). All four indices remained greater than zero after Holm correction (all pHolm < 0.001), and all remained greater than the matched ahead-gaze sector indices (all pHolm < 0.001). Threshold sensitivity analysis across cut-offs from 0.30 to 0.40 showed that the positive directional pattern was preserved for all gaze directions. Conclusions: Tear-film quality varies regionally with gaze direction, a pattern that was clearer in spatial maps and sector indices than in global summaries. Straight-ahead measurements may therefore provide an incomplete account of tear-film behaviour during eccentric gaze. As the analysis involved healthy participants and did not assess symptoms or diagnostic performance, the clinical relevance of this pattern requires validation in symptomatic populations. Full article

Aramid nanofibers (ANFs) inherit the exceptional properties of the bulk counterparts, while introducing a large specific surface area and excellent processability. However, the strong inter-fibrillar interactions and tendency to agglomerate hinder their high-content incorporation into polymer matrices. Here, we report a one-pot reprotonation–compounding strategy for fabricating aramid nanofiber-reinforced poly(vinyl alcohol) (ANF–PVA) composite films, where the ANF dispersion was mixed with polymers during the protonation process to form a continuous 3D network in the ANF-PVA film. The optimized film with a loading of 20 wt% ANFs exhibited a tensile strength of 122.2 MPa and a toughness of 28.36 J m⁻³. Furthermore, the high ANF loading enabled versatile applications. A robust ANF-PVA hydrogel, prepared via salt-induced gelation, delivered 132% enhancement in tear strength and 38.2% increase in cyclic compressive strength compared with the PVA hydrogel. Moreover, inspired by the “brick-and-mortar” architecture of natural nacre, the fully organic ANF-PVA film was incorporated into carbon fiber/epoxy laminates, with a configuration of one nacre-inspired film per five prepreg plies, achieving a 36.5% improvement in impact toughness and minimal loss in flexural strength. This scalable reprotonation–compounding approach provides a general route for producing high-loading ANF-based composites, paving the way for the broader utilization in advanced materials. Full article

Toxic epidermal necrolysis (TEN) is a rare, life-threatening mucocutaneous adverse drug reaction associated with extensive epidermal necrosis and severe systemic complications. We report the case of a 25-year-old woman who developed severe lamotrigine-induced TEN four weeks after treatment initiation. The disease rapidly progressed to involve approximately 60% of the body surface area, requiring intensive care unit admission, mechanical ventilation, and multidisciplinary management. Treatment included high-dose intravenous methylprednisolone, intravenous immunoglobulins, etanercept, plasmapheresis, and comprehensive supportive care. During hospitalization, the patient developed gastrointestinal complications manifested by pneumatosis intestinalis and portal venous gas, raising suspicion of bowel ischemia and prompting exploratory laparotomy. Following treatment, gradual clinical improvement and complete resolution of the cutaneous lesions were achieved. However, persistent ocular sequelae developed, including meibomian gland dysfunction, punctate epithelial erosions, conjunctival scarring, trichiasis, tear film instability, and early corneal neovascularization, requiring long-term ophthalmological follow-up. To provide clinical context, a narrative review of the literature on the diagnosis, multidisciplinary management, gastrointestinal manifestations, ocular complications, and systemic treatment of TEN was performed. A comprehensive literature search was conducted to identify relevant articles focusing on the intensive care management and specific organ-related manifestations of Toxic Epidermal Necrolysis (TEN). The gathered literature was narratively synthesized to present a cohesive update on current clinical practices and management controversies. This case highlights the potentially devastating multiorgan course of TEN and emphasizes the importance of early recognition, specialized intensive care, and long-term multidisciplinary follow-up. Full article

Environmental stressors like low temperature, low relative humidity (RH), and particulate matter (PM2.5), promote tear film instability and dry eye disease. This study investigates how these conditions alter the interfacial behavior of meibomian gland secretion (MGS) films in vitro and evaluates the capacity of mucomimetic polymers (0.5% hyaluronic acid [HA], polyvinylpyrrolidone [PVP], and chondroitin sulfate [CHS]) to suppress these impacts. MGS films over polymer-containing aqueous subphases were analyzed using a Langmuir trough and Brewster angle microscopy under adverse conditions (20 °C subphase, 20% RH, PM2.5 exposure). A sophisticated analytical framework was developed to evaluate MGS duplex multilayers: (i) a Volmer equation-based 2D-VES model to probe interfacial molecular properties (limiting area, compressibility, cohesion pressure) and (ii) a combined Maxwell viscoelastic and diffusion-relaxation model to quantify the dilatational relaxation modulus. Results indicate that despite their distinct nature, environmental stressors similarly disrupt the multilayer structure, reorganization, and rheological properties of MGS layers during blink-like deformations. Polymer supplementation moderated these adverse effects, yielding partial recovery of film structure and isothermal reversibility. Distinct mechanisms of action for HA, PVP, and CHS at the film/aqueous interface are elucidated. Full article

Background/Objectives: Fibromyalgia (FM) is a multifactorial disorder characterized by chronic pain, fatigue, asthenia, and sleep disturbances. FM may have effects on the eyes, such as dry eye disease (DED) and retinal changes. The aim of this study is to evaluate these ocular changes in FM patients. Methods: It is a single-center prospective study. Forty-two female patients with FM (Group 1) and 37 healthy controls (Group 2) participated in the study. Study participants underwent screening tests for DED and the retinal nerve fiber layer (RNFL) thickness. Results: According to the Schirmer test, Group 1 had lower scores with a significant difference (8.2 ± 4.36 mm vs. 17.51 ± 2.41 mm). When the tear film breakup time (TBUT) test values were analyzed, there was a significant difference between groups; Group 1 had lower scores (4.95 ± 2.26 s vs. 9.86 ± 1.64 s). When the RNFL thickness values were analyzed by quadrants, our results in Group 1 FM patients were lower in the superior temporal quadrant (117.98 ± 13.98 µm vs. 124.35 ± 13.71 µm). Conclusions: These findings indicate that patients with fibromyalgia may have increased dry eye findings and localized RNFL thinning, suggesting that fibromyalgia may be associated with both anterior and posterior segment ocular alterations. However, these parameters should be interpreted as ocular manifestations rather than diagnostic markers. Further studies are needed to determine their clinical relevance and potential biomarker value. Full article

Specialized pro-resolving mediators (SPMs) are endogenous lipid mediators that actively orchestrate the resolution of inflammation rather than relying solely on broad suppression of inflammatory signaling. At the ocular surface, lipoxins, resolvins, protectins, maresins, and related pro-resolving mediators regulate epithelial repair, leukocyte responses, angiogenesis, conjunctival goblet-cell secretion, tear-film homeostasis, and corneal nerve regeneration. This review synthesizes evidence for local SPM biosynthesis and receptor signaling in the cornea and conjunctiva, together with tear lipid mediator profiling, with emphasis on anterior-segment and ocular-surface disease models. Particular attention is given to the endogenous lipoxin A4 circuit, resolvin-mediated control of corneal inflammation and viral keratitis, docosanoid regulation of corneal nerve regeneration, SPM modulation of conjunctival goblet-cell mucin secretion, tear lipid mediator signatures, and the translational development of resolvin E1 (RvE1)-based analogs for dry eye disease. Current evidence positions SPMs as mechanistically distinct therapeutic candidates for ocular-surface disease; however, clinical translation will require optimized delivery, biomarker-guided patient selection, and rigorous validation in disease-state cohorts. Full article

Dry eye disease (DED) is a multifactorial ocular surface disorder characterized by inflammation, oxidative stress, tear film instability, and secretory dysfunction. This study investigated the protective effects of Lute-gen^®, a lutein and zeaxanthin-based formulation, in both in vitro and in vivo DED models. Human corneal epithelial (HCE-T) cells were stimulated with TNF-α, while dry eye was induced in female Sprague–Dawley rats using subcutaneous scopolamine (SCP) administration. In HCE-T cells, Lute-gen^® showed no cytotoxicity, restored cell viability, reduced intracellular ROS, and was associated with increased expression of antioxidant-related markers (Nrf2, HO-1, SOD, CAT, and GPx), reduced expression of inflammatory mediators (TLR4/MyD88/NF-κB/NLRP3), and increased expression of AQP3 and AQP5. In SCP-induced rats, Lute-gen^® significantly improved tear secretion and reduced corneal fluorescein staining. Histopathological analyses revealed restoration of conjunctival goblet cells, mucin staining, corneal epithelial integrity, acinar area and cell density, and lacrimal gland architecture, with reduced inflammatory infiltration. Immunofluorescence further demonstrated reduced TLR4 and MMP9 immunoreactivity and decreased CD68⁺ inflammatory cell infiltration. Molecular analyses showed reduced expression of inflammatory cytokines and NF-κB/MAPK/MMP signaling-related inflammatory mediators, together with restoration of AQP1, AQP3, and AQP5 expression in corneal tissues. Collectively, these findings suggest that Lute-gen^® treatment was associated with improvements in dry eye-related pathological changes, including restoration of antioxidant-related markers, attenuation of inflammatory responses, restoration of aquaporin expression, and preservation of ocular surface and lacrimal gland integrity. These preclinical findings support further mechanistic investigations and the future clinical evaluation of Lute-gen^® as a potential nutritional intervention for dry eye disease. Full article

Tear film instability and dry eye disease (DED) are among the most common postoperative complaints after anterior segment surgery. Cataract surgery, corneal refractive procedures, keratoplasty, glaucoma filtration surgery, and pterygium excision can all disrupt ocular surface homeostasis through mechanisms that include corneal denervation, inflammation, goblet cell loss, and meibomian gland dysfunction. The severity and duration of postoperative dry eye vary substantially according to the surgical procedure performed. This review summarises current evidence on the pathophysiology, clinical manifestations, objective tear film changes, and recovery patterns following major anterior segment interventions. Particular emphasis is placed on standardised, non-invasive assessment methods, including tear breakup time, tear meniscus height, meibography, and validated symptom questionnaires. Procedure-specific recovery trajectories are compared to distinguish transient postoperative tear film instability from persistent chronic dry eye disease. Evidence-based management strategies, including preoperative risk stratification, intraoperative optimisation, and multimodal postoperative therapy, are also reviewed. Understanding these distinct recovery patterns may improve surgical planning, patient counselling, early intervention, visual outcomes, and patient satisfaction. 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/Objectives: To investigate the relationship between lacrimal punctum size and the severity of dry eye disease (DED) in a clinically refractory, real-world patient cohort from a tertiary ophthalmology center in Lebanon. Methods: A retrospective observational study was conducted at Advanced Eye Care Center, Beirut, Lebanon (2016–2024). A total of 312 eyes from 156 patients with moderate-to-severe DED unresponsive to topical artificial tears, loteprednol etabonate, and cyclosporine (0.05% ophthalmic emulsion) were included. All eyes subsequently underwent lower lacrimal punctum plug insertion as part of clinical management. Lacrimal punctal diameter was estimated by the largest silicone plug (0.5 mm, 0.6 mm, or 0.7 mm) inserted nonforcefully into the lower punctum under slit-lamp visualization. Tear film stability was assessed by Tear Break-Up Time (TBUT). Group differences were analyzed using the Kruskal–Wallis H test with post hoc Mann–Whitney U tests (Bonferroni correction), and Spearman’s rank correlation was calculated to quantify the monotonic association. Results: Eyes were distributed across punctal diameter categories as follows: 0.5 mm (n = 15, 4.8%), 0.6 mm (n = 204, 65.4%), and 0.7 mm (n = 93, 29.8%). Median TBUT values were 5.55 s [IQR 5.51–5.77], 5.06 s [IQR 4.80–5.37], and 4.51 s [IQR 4.23–4.71] for the 0.5 mm, 0.6 mm, and 0.7 mm groups, respectively. Kruskal–Wallis analysis confirmed significant inter-group differences (H = 140.1, p < 0.001). All post hoc pairwise comparisons remained significant after Bonferroni correction (p < 0.001). Spearman’s rank correlation demonstrated a significant negative association between lacrimal punctal diameter and TBUT (ρ = −0.70, p < 0.000001). All analyses were conducted at the eye level and do not account for within-patient correlation (bilateral design, 156 patients); p-values should be interpreted accordingly. Conclusions: In this treatment-refractory cohort, larger lacrimal punctal diameter was significantly associated with greater tear film instability. These findings suggest that lacrimal punctal diameter estimation during therapeutic plug insertion may serve as a practical, cost-free adjunct to standard DED evaluation. Prospective multimodal studies are needed to validate punctal diameter as an independent clinical indicator of DED severity. Full article

Background: Dry Eye Disease (DED) is a multifactorial ocular surface disorder characterized by tear film instability and inflammation. Cyclosporine A, an immunomodulator, and Diquafosol sodium, a mucin secretagogue, represent two distinct therapeutic pathways. However, current evidence directly comparing their clinical efficacy is inconsistent. This meta-analysis aimed to compare treatment outcomes and efficacy between 0.05% Cyclosporine A and 3% Diquafosol sodium in patients with moderate-to-severe DED. Methods: In January 2026, we conducted a systematic search of PubMed, Scopus, Web of Science, and the Cochrane Library for randomized controlled trials directly comparing 0.05% Cyclosporine A to 3% Diquafosol sodium in adult patients with moderate-to-severe DED. For the meta-analysis, we used R 4.5.0 with R Studio 2024.12.1+563. Results: We included six RCTs with a total of 859 patients. No significant differences were found between Cyclosporine A and Diquafosol sodium in Tear Break-Up Time (TBUT) at 4, 8, or 12 weeks. Cyclosporine A showed a suggestive greater improvement in Schirmer test scores at 4 weeks (SMD = 0.35, 95% CI 0.07 to 0.63). A modest benefit in symptom scores favoring Diquafosol sodium was observed at 12 weeks (SMD = 0.23, 95% CI 0.06 to 0.41). Subgroup analysis suggested this symptomatic benefit may be more pronounced in patients with severe disease, although subgroup interaction tests were not statistically significant. There were no significant differences in corneal or conjunctival staining at any time point. The risk of adverse events did not differ significantly between treatments. Conclusions: Early improvement in tear production showed a potential benefit for Cyclosporine A, while longer-term symptomatic relief showed a potential benefit for Diquafosol sodium, with suggestive evidence in severe disease. However, these findings should be interpreted cautiously, given the methodological limitations and inconclusive TSA evidence for several outcomes. Future large-scale, standardized trials with extended follow-up are warranted to confirm these findings. Full article

Background/Objectives: The goal of this study was to show the consistency between the inflammatory and anti-inflammatory response in the early postoperative period after corneal refractive surgery (LASIK and PRK), represented by the levels of specific cytokines in the tear film. Materials/Methods: A total of 68 myopic eyes (31 in the LASIK and 37 in the PRK group) had 3 samples of tear film taken, one before surgery (t₀), another 1 h after surgery (t₁) and the third 24 h after surgery (t₂). The tear samples were then analyzed by flow cytometry in order to determine the levels of pro-inflammatory cytokines (IL-1β, IL-6, IL-8, IFN-γ, TNF-α) and the levels of anti-inflammatory cytokines (IL-4, IL-10). Results: A statistically significant positive correlation was found between the concentrations of all pro-inflammatory cytokines (IL-1β, IL-6, IL-8, IFN-γ, TNF-α) and all anti-inflammatory cytokines (IL-4, IL-10), respectively, for both t₁ and t₂ in the group of eyes that underwent LASIK. In the PRK group, there was a statistically significant positive correlation for all cytokines (pro-inflammatory and anti-inflammatory) at t₁; however at t_2, there was no correlation between IL-1β and IL-10, IL-6 and IL-10, IL-8 and IL-10, and IFN-γ and IL-10. In contrast, for other correlations between pro-inflammatory and anti-inflammatory cytokines in the same observation time (t₂), a positive correlation was observed. Conclusions: There is a consistency between the inflammatory and anti-inflammatory responses in the early postoperative period after refractive surgery, which persists longer after LASIK compared to PRK. This difference may explain the different clinical courses in patients after undergoing these procedures. Full article

Background: Long-duration spaceflight (LDSF) poses unique challenges to ocular health as microgravity, radiation, and environmental changes can cause lasting visual and structural impairments that affect astronaut performance. Objective: This review synthesises current evidence on in- and post-flight ocular complications. It integrates clinical findings, terrestrial analogues, animal studies, and theoretical models to characterise the pathophysiology, risk factors, and countermeasures associated with spaceflight-induced ocular changes. Methods: A review of peer-reviewed literature was conducted, focusing on dry eye disease, corneal edema, ocular biometric shifts, spaceflight associated neuro-ocular syndrome (SANS), and radiation-induced cataractogenesis. Data from in-flight imaging, post-flight assessments, and ground-based analogues were analysed. Results: Spaceflight induces multifactorial ocular changes, including tear film instability, optic disc edema, posterior globe flattening, and hyperopic refractive shifts. These effects are thought to result from cephalad fluid shifts compartmentalised cerebrospinal fluid pressure, venous congestion, and impaired glymphatic system. Long-term risks, such as cataractogenesis, are linked to radiation exposure and genetic susceptibility. Although several countermeasures are being explored, no single approach fully prevents these complications. Conclusions: Ocular complications during LDSF remain a significant challenge for astronaut health and mission performance. A multimodal approach combining mechanical, nutritional, and diagnostic strategies will be essential for future exploration-class missions. Further research is needed to refine countermeasures and preserve astronauts’ visual function. Full article

Background/Objectives: To evaluate early postoperative changes in scleral and iris thicknesses together with corneal layer thicknesses and tomographic parameters following corneal collagen cross-linking (CXL) in eyes with progressive keratoconus. Methods: This retrospective study included 94 eyes of 94 patients with progressive keratoconus who underwent standard epithelium-off CXL using the Dresden protocol. Corneal tomography (Pentacam) and anterior segment optical coherence tomography (AS-OCT) measurements were obtained preoperatively and at the early postoperative follow-up (3 months ± 2 weeks). Thickness measurements of the tear film, corneal epithelium, Bowman layer, stroma, Descemet–endothelium complex, sclera (1–3 mm from the limbus), and iris (1–2 mm from the pupillary margin) were analyzed. Pre- and post-CXL values were compared using paired statistical tests, and effect sizes were calculated. Results: In the early postoperative period, scleral thickness showed a significant increase at all measured distances from the limbus, with medium effect sizes, while iris thickness demonstrated a significant decrease at all measurement points with large effect sizes (p < 0.001). Tear film, epithelial, and stromal thicknesses decreased significantly after CXL, whereas Bowman layer and Descemet–endothelium complex thicknesses remained unchanged. Pachymetric measurements revealed significant thinning at the pupil center, corneal apex, and thinnest point. No significant changes were observed in Kmax or anterior chamber depth, indicating stabilization rather than progression in the early postoperative period. Conclusions: Corneal collagen cross-linking was associated with measurable early structural changes in corneal layers and extra-corneal anterior segment tissues during the postoperative period. The observed increase in scleral thickness and decrease in iris thickness suggest that structural alterations may occur in extra-corneal anterior segment tissues following CXL. These findings support the concept that CXL influences anterior segment biomechanics in a tissue-specific manner and that extra-corneal parameters may serve as complementary markers for early postoperative assessment. Full article