Ocular surface diseases (OSDs) are a heterogeneous group of disorders characterized by overlapping inflammatory, vascular, microbial, neuroimmune, and meibomian gland abnormalities that contribute to the onset and persistence of ocular surface symptoms and signs. Conventional symptom-directed therapies do not adequately alleviate refractory meibomian gland dysfunction, Demodex-associated blepharitis, ocular rosacea, recurrent chalazion, and allergic conjunctivitis. Recent evidence suggests that these conditions may share convergent pathological features, including chronic inflammation, abnormal lid-margin vascularity, and microbial or parasitic imbalance. Intense pulsed light (IPL), which was initially used for vascular and inflammatory disorders in dermatology, has emerged as a potential physical therapy that acts through several proposed mechanisms in patients with selected refractory OSDs, including photothermal liquefaction of inspissated meibum, coagulation of abnormal vessels, reduction of Demodex and microbial burden, modulation of inflammatory responses, and possible effects on neuroimmune signaling; however, these mechanisms remain incompletely established. Case series and clinical studies have reported improvements in ocular symptoms, tear film stability, meibomian gland function and drainage, lid-margin inflammation, and chalazion or lesion resolution, particularly when IPL is combined with meibomian gland expression or other adjunctive therapies. However, treatment responses vary across disease phenotypes and standardized treatment parameters, long-term safety data, and high-quality randomized controlled trials remain limited. Anatomical factors, disease severity, glandular structure, and inflammatory status may also influence therapeutic outcomes. Overall, IPL therapy represents a promising but evolving treatment strategy for refractory OSDs. This review summarizes the current knowledge regarding the proposed mechanisms, clinical applications, treatment protocols, limitations, and future directions and provides updated perspectives for the rational use of IPL in OSD management.

Acquired distichiasis is an uncommon eyelid disorder characterized by an accessory row of eyelashes arising from the meibomian gland orifices, most often in the setting of chronic inflammatory or cicatricial disease. We report a case of a 65-year-old woman with longstanding dermatomyositis, recurrent periocular inflammation, and episodes of blepharitis who developed bilateral upper-eyelid distichiasis. Review of clinical photographs from 2020 and from a severe periocular flare in 2023 showed no clearly visible accessory row. At follow-up in January 2026, clinical and dermoscopic examination demonstrated bilateral accessory rows of long, pigmented eyelashes, findings consistent with acquired distichiasis. The patient had no ocular irritation or visual symptoms, and ophthalmologic evaluation found neither trichiasis nor corneal involvement. There was no history of Stevens-Johnson syndrome, ocular cicatricial pemphigoid, trachoma, chemical injury, or eyelid surgery. However, recurrent blepharitis and previous exposure to docetaxel in 2018 were important alternative or contributing factors. Chronic periocular inflammation associated with dermatomyositis may have promoted eyelid margin remodeling and metaplastic changes in the meibomian glands, but a causal relationship cannot be established from a single case. Because the patient was asymptomatic and had no corneal complications, observation with regular ophthalmologic monitoring was selected. This case highlights the need to examine the eyelid margins in patients with chronic periocular inflammation and to consider both inflammatory and treatment-related contributors to acquired distichiasis.

Glucagon-like peptide-1 (GLP-1) and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonists are increasingly prescribed for obesity and type 2 diabetes, but eyelid gland pathology has not previously been reported with these agents. We describe what we believe to be the first reported case series of 2 patients who developed multiple simultaneous internal hordeola after starting tirzepatide, a dual GLP-1/GIP receptor agonist. Patient 1, a 44-year-old woman, developed 6 simultaneous hordeola 4 weeks after dose escalation, 5 of which progressed to chalazia; lesions lessened after tirzepatide discontinuation and worsened upon rechallenge, a positive rechallenge providing strong evidence of causality. Patient 2, a 73-year-old woman with mild pre-existing blepharitis, developed 6 simultaneous hordeola 10 weeks after initiation of her 5 mg dose, 2 of which progressed to chalazia. Both patients lacked classic infectious blepharitis signs despite active lesions, supporting a sterile, obstructive meibomian gland process rather than infection, though both found the recurrences bothersome. These cases suggest a possible, previously undescribed association between tirzepatide and simultaneous or recurrent meibomian gland obstruction. Clinicians should be aware of this potential adverse eyelid effect and pursue conservative ophthalmic management before considering medication changes.

Background: Dry eye disease (DED) and meibomian gland dysfunction (MGD) impose a significant global burden, yet clinical practice varies substantially between regions. This study investigated international trends in DED diagnosis and management among eye care practitioners (ECPs), with regional focus on South Africa (SA), the United Kingdom (UK) and the rest of the world (RoW; heterogeneous international respondents). Methods: An anonymised cross-sectional online survey was distributed to ECPs globally (May 2023-September 2024). In total, 383 participants from 31 countries were included in the analysis (SA n = 137; UK n = 112; RoW n = 134). Mann-Whitney U tests with Benjamini-Hochberg false discovery rate correction, chi-square tests and Kendall's tau concordance were applied. Results: SA practitioners reported significantly lower confidence across all four DED domains than their UK and RoW counterparts (all q < 0.05; Cliff's delta small-to-medium). Core diagnostic practices-case history (88.7%), fluorescein staining (79.4%) and tear break-up time (77.3%)-were globally consistent. UK practitioners showed greater recognition of blepharitis and higher uptake of lid massage, dietary modification and intense pulsed light. Advanced diagnostics received low reported importance globally. Conclusions: Significant regional disparities exist in practitioner confidence, diagnostic emphasis and therapeutic access. A tiered diagnostic framework is proposed to support equitable care, applying a universal core of assessments supplemented by advanced tools where resources permit.

Ocular infections can affect the ocular surface and adnexal structures, intraocular structures, or both. Infections of the ocular surface and adnexa often arise from the invasion of commensals when typical barriers are compromised, which includes infectious blepharitis, conjunctivitis, keratitis, dacryocystitis, and orbital infections, among others. Intraocular infections may develop due to localised trauma or as part of a systemic condition. A variety of viruses, bacteria, fungi, protozoa, and helminths can cause intraocular illness. Occasionally, ocular abnormalities are the only external clinical indications of systemic infectious diseases. Analyzing specimens from ocular tissues or fluids can aid in diagnosing ocular infectious diseases and may help identify systemic infections. The management of ocular illnesses generally involves the topical application of antimicrobials and anti-inflammatory agents, along with targeted therapy addressing the underlying etiologies. In some cases, systemic antibacterial agents or glucocorticoids may be necessary. Addressing an inflamed or infected eye in an emergency context poses a diagnostic and therapeutic challenge for the emergency physician, with aetiology and prognoses varying from benign, self-limiting conditions to organ-threatening diseases. To address these ocular infections, the market has evolved with various therapeutics-based eye drops that are instilled specifically into the lower precorneal pocket and are regarded as the most patient-compliant method of drug delivery. Nevertheless, the efficacy of this approach is significantly reduced by the blink reflex, resulting in the loss of most of the topical dose. In this regard, nanosuspensions, which disperse hydrophobic drugs in an aqueous medium stabilised by surfactants, offer a promising strategy for mitigating ocular infections. Overall, this review aims to thoroughly examine the applicability of nanosuspensions in ocular drug delivery to target and treat infections in the human eye.

Ophthalmologic symptoms are reported in 10-67% of psoriasis (Ps) cases and affect up to 31% of patients with psoriatic arthritis (PsA). The most common include blepharitis, eyelid involvement, uveitis, dry eye syndrome, conjunctivitis, corneal changes, and cataract. Despite the relatively common eye involvement, these symptoms are often overlooked or inadequately managed. Therefore, dermatologists and rheumatologists should interview patients for eye-related complaints to effectively identify and treat patients with ocular manifestations. In some cases, direct collaboration with ophthalmologists is also necessary for comprehensive patient management. The purpose of this intradisciplinary review is to discuss the most common eye symptoms among Ps and PsA patients, which should be considered as a basis for formulating guidelines for Ps treatment by dermatologists, ophthalmologists, rheumatologists, general practitioners and other specialists. In addition, we propose a simple diagnostic and therapeutic algorithm to facilitate the management of patients with Ps and accompanying symptoms of uveitis.

Ocular allergy represents one of the most frequent yet under-recognized manifestations of pediatric allergic disorders, affecting up to 30% of children worldwide. The disease encompasses a spectrum ranging from mild, intermittent seasonal or perennial allergic conjunctivitis to severe, vision-threatening forms such as vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC). Despite its high prevalence and the strong association with systemic allergic diseases-including asthma, allergic rhinitis, and atopic dermatitis-the involvement of pediatric allergists in routine ocular allergy care remains limited. This review proposes an interdisciplinary framework that integrates allergists more centrally into ocular allergy management. A structured approach to diagnosis highlights the allergist's essential role in identifying systemic triggers, performing allergy testing, and differentiating ocular allergy from mimics such as viral conjunctivitis, blepharitis, and autoimmune ocular surface disease. Management, as a stepwise, collaborative strategy beginning with allergen avoidance and topical dual-acting antihistamine/mast-cell stabilizers, progressing to steroid-sparing immunomodulators, systemic therapy, and advanced options such as allergen immunotherapy, emerging biologic treatments, including omalizumab and dupilumab, is discussed in the context of severe VKC and AKC, along with benefits, limitations, and need for ophthalmic oversight. This framework underscores the importance of timely referral from ophthalmologists to pediatric allergists, co-management of complex cases, and early integration of systemic allergy care. Through interdisciplinary collaboration, long-term visual outcomes can be improved and inappropriate steroid use minimized. A practical interdisciplinary care pathway and treatment escalation algorithm are proposed to facilitate real-world collaborative management.