Streptococcus intermedius, a commensal bacterium in the human oral cavity, can occasionally cause severe infections in deep tissues. The patient was referred because of a conjunctival tumor. She had severe nasal cavity and periocular tissue inflammation that persisted for over a year. Microbiological examination of the nasal and ocular specimens identified S. intermedius as the pathogenic strain. The inflammation and the conjunctival mass subsided after systemic and topical administration of a susceptible antibiotic. Smear microscopy of the eye and nasal discharge was useful for the differential diagnosis. 16S metagenomic analysis using MinION as an adjunctive diagnostic tool has contributed to the species identification of the pathogenic strain.

Allergic eye disease affects 15-40% of people worldwide, particularly children and adolescents, and often coexists with atopic dermatitis, allergic asthma, and allergic rhinitis. To capture the latest insights into its causes, presentation and management, the authors performed a comprehensive PubMed/MEDLINE literature review through April 2025 using multiple search terms such as 'ocular allergy', 'allergic conjunctivitis', 'Seasonal Allergic Conjunctivitis', 'Perennial Allergic Conjunctivitis', 'Atopic Keratoconjunctivitis', 'Giant Papillary Conjunctivitis', "Contact Blepharoconjunctivitis, 'Vernal Keratoconjunctivitis', 'Shield Ulcers', 'immunology', 'allergic rhinitis', and related terminologies. The current review review integrates epidemiological data, mechanistic studies and clinical guidelines to offer a cohesive overview of this condition. Allergic eye disease arises when environmental allergens trigger an IgE-mediated immune response in the eye, leading to inflammation that ranges from mild seasonal redness and itching to severe forms with tissue changes and corneal involvement. Diagnosis depends on the history and eye examination of a patient, with ancillary tests used only when the presentation is unclear. Management begins with allergen avoidance, lubricating drops and cold compresses, progressing to topical antihistamines or mast-cell stabilisers and short-course corticosteroids for flares. Looking ahead, newer treatments such as calcineurin inhibitors, monoclonal antibodies against key inflammatory cytokines and targeted small-molecule drugs are expanding the ability to control symptoms without long-term steroid use. Given its chronic, relapsing nature and potential to cause ocular surface damage, corneal complications, and visual morbidity, early recognition and stage-appropriate management of allergic eye disease are essential in routine clinical practice to preserve ocular surface integrity, maintain visual function, and improve patient quality of life.

Myxomatosis is a severe viral disease of lagomorphs that has recently seen the emergence of a recombinant myxoma virus (MYXV). Data from Africa remain scarce. Here we report the first confirmed detection and genomic characterization of a recombinant MYXV in Algeria. Two domestic rabbits from a backyard smallholding in El Affroun (Blida province) were presented on 19 October 2022 with classical signs of myxomatosis, including marked facial edema, severe mucopurulent blepharoconjunctivitis, and respiratory involvement. Necropsy and histopathology showed lesions typical of myxomatosis (epithelial hyperplasia with ballooning degeneration, intracytoplasmic inclusions, ulceration, stromal expansion by myxoma cells, and vascular hyperemia and leukostasis). MYXV DNA was detected in multiple tissues from both animals, and virus isolation on RK-13 cells produced cytopathic effects (CPEs) by days 5-7 postinoculation. The Algerian MYXV sequence showed >99.9% nucleotide identity to the MYXV Toledo strain (GenBank Accession Number MK836424.1). Phylogenetic analysis placed the Algerian strain within the recombinant ha-MYXV cluster, between earlier Spanish sequences (2018) and more recent Northern European sequences (2024), with the most recent common ancestor estimated around January 2017 (95% HPD July 2015-May 2018). These findings extend the known range of recombinant MYXV beyond Europe and highlight introduction risks at the pet-farm-wildlife interface in North Africa. We recommend strengthened vaccination of pet and farmed rabbits, pragmatic biosecurity in smallholdings, and targeted surveillance of hare populations to clarify sources and transmission routes.

Phthiriasis palpebrarum is a rare infestation of the eyelids caused by Phthirus pubis. This condition is particularly noteworthy as it is a rare cause of red eyes in children and can often be confused with other forms of blepharoconjunctivitis. In this study, we examined an 11-year-old male patient who was brought to our clinic by his family and presented with redness and itching in both eyes that had persisted for a month. Biomicroscopic examination revealed two live lice with mobile legs and a semi-transparent appearance on the eyelashes of both upper eyelids, together with a large number of eggs, particularly concentrated on the right eye. No foreign body was found in the eye. After the necessary protective measures had been taken, the lice and their eggs were carefully removed from the eyelashes using forceps. The parasitological examination of eyelash samples confirmed the presence of adult lice and eggs of Phthirus pubis. After a suitable treatment plan was developed and detailed hygiene recommendations were thoroughly explained, the patient was discharged. During the follow-up examination conducted one week later, no lice or eggs were detected on the eyelashes, and the blepharoconjunctivitis had regressed.

Varicella-Zoster Virus (VZV) is one of the most important pathogens in ophthalmology. Reactivation may involve the adnexa (blepharoconjunctivitis, pseudomembranous conjunctivitis), cornea (dendritic keratitis, nummular and necrotizing stromal keratitis, disciform endotheliitis, neurotrophic ulcers, mucous-plaque keratitis) and sclera (episcleritis, anterior scleritis). Uveal inflammation ranges from anterior uveitis-with iris atrophy, trabeculitis-induced glaucoma and complicated cataract-to posterior necrotizing syndromes: acute retinal necrosis in immunocompetent hosts and progressive outer retinal necrosis in immunosuppressed patients, often complicated by occlusive vasculitis, macular edema, retinal detachment and phthisis. Optic nerve and cranial nerve involvement (optic neuritis, neuroretinitis, III/IV/VI palsies) and orbital inflammation may occur even without cutaneous signs ("zoster sine herpete"), making PCR-based intraocular diagnostics essential. Management relies on early, high-dose antivirals (acyclovir or valacyclovir), judicious corticosteroids and timely surgical intervention when required. Universal childhood varicella vaccination and recombinant zoster vaccination in adults ≥50 years have reduced VZV incidence and ocular complications in settings with high vaccine coverage, though rare post-vaccine keratitis or uveitis underscore the need for ongoing vigilance. In this review, we synthesize current knowledge on varicella-zoster virus ocular disease, with a focus on host-pathogen interactions that drive both injury and defense.

PURPOSE: To determine whether chronic exposure to ambient air pollutants increases the risk of blepharitis and blepharoconjunctivitis in a nationwide population. METHODS: We assembled a retrospective cohort of 552 965 adults (≥ 20 years) in Taiwan’s National Health Insurance Research Database who were free of ocular surface disease at baseline and followed them from 2000 to 2013. Ten-year mean concentrations of sulfur dioxide (SO2), carbon monoxide (CO), particulate matter ≤ 10 µm (PM10) and ≤ 2.5 µm (PM2.5), nitrogen oxides (NOX), nitric oxide (NO), nitrogen dioxide (NO2), total hydrocarbons (THC), non-methane hydrocarbons (NMHC), methane (CH4), and ozone (O3) were assigned by linking residential postcodes to 76 monitoring stations. Cox proportional-hazards models estimated hazard ratios (HRs) per 1-standard deviation (SD) increase, adjusting for demographics, socioeconomic status, smoking, comorbidities, ambient temperature, season, and short-term pollutant levels. RESULTS: Over 6.4 million person-years, 20,752 participants developed blepharitis/blepharoconjunctivitis. Kaplan–Meier curves demonstrated progressively higher cumulative incidence across increasing tertiles of 10-year pollutant exposure (log-rank P < 0.001). Adjusted HRs (per 1-SD) were: SO2 1.33, CO 1.98, PM10 1.76, PM2.5 1.95, NOX 1.72, NO 1.55, NO2 1.75, THC 1.90, NMHC 1.34, and CH4 2.65 (all P < 0.001), whereas ozone was inversely associated with risk (HR 0.46). Estimates were similar in sex- and younger-age–stratified analyses. CONCLUSION: Decade-long exposure to multiple common air pollutants is independently associated with a 33%–165% increase in the risk of blepharitis and blepharoconjunctivitis, while ozone showed an inverse association. These findings underscore the importance of pollution control strategies in reducing the population burden of ocular surface disease.

With several international outbreaks ongoing, mpox-related eye disease is increasingly detected, yet data on its prevalence remain limited. We conducted a descriptive cross-sectional study in four health zones in South-Kivu Province, Democratic Republic of the Congo, between November 1, 2024 and January 31, 2025, to describe the clinical features of mpox-related ophthalmic disease in hospitalized patients during the ongoing clade Ib outbreak. Routine ophthalmic examination was performed in laboratory-confirmed hospitalized mpox patients. The assessment included visual acuity measurement, inspection of eyelids and ocular surface with a magnifying glass, portable slit lamp biomicroscopy of the anterior segment, and ophthalmoscopy. We examined a total of 366 patients, of whom 210 (57.4%) were male. The median (IQR) age was 8 (4-16) years, 260 (71%) of the patients were younger than 15, and 168 (45.8%) were under 5. Ocular symptoms and disease were recorded in 190 (51.9%) patients. The most common ocular symptom was redness (51.9%), followed by pain (20.0%), itching (18.3%), and conjunctival discharge (16.7%). Conjunctivitis was observed in 113 (30.9%) patients. Other manifestations included blepharoconjunctivitis (7.4%), blepharitis (5.2%), and keratoconjunctivitis (3.3%). Ulcerative and non-ulcerative keratitis were present in 2.5% and 2.2% of the patients, respectively. Two (0.6%) HIV-positive patients had herpes zoster ophthalmicus. Visual impairment was recorded in 5.7% and blindness in 2.5% of the patients. Ophthalmologic manifestations were common during hospitalization in this group of patients. The early occurrence of ophthalmic manifestations requires early ophthalmic assessment for timely diagnosis and treatment to achieve better outcomes. Outbreak frontline healthcare workers should be alert of ocular symptoms such as redness, pain, sensitivity to light, and tearing in both suspected and laboratory-confirmed cases and promptly initiate an ophthalmic evaluation.

Ocular allergy encompasses a heterogeneous group of diseases with overlapping clinical features and complex immunopathological mechanisms. This often creates challenges in classification and, consequently, in optimizing patient management. The nomenclature published in 2023 by the European Academy of Allergy and Clinical Immunology (EAACI) addresses these issues by redefining these conditions and linking clinical phenotypes and environmental modifiers to underlying types of hypersensitivity. This framework enhances diagnostic precision and supports mechanism-guided management. This article applies the EAACI approach based on hypersensitivity types to ocular allergy. The examples addressed include seasonal and perennial allergic conjunctivitis, driven mainly by type I and IV hypersensitivity reactions; vernal and atopic keratoconjunctivitis, involving mixed type I, IVb and IVa pathways; giant papillary conjunctivitis, a tissue-driven type V reaction; and contact blepharoconjunctivitis, a type IVa delayed hypersensitivity reaction with additional components. Distinct endotypes-such as local or acute allergic conjunctivitis, dupilumab-induced ocular disease, and vernal keratoconjunctivitis/atopic keratoconjunctivitis overlap-further illustrate heterogeneity, with the ocular surface microbiome emerging as a modifier. Diagnostics are increasingly aligning with mechanisms, and the EAACI framework translates this complexity into a mechanism-indexed map; this supports the selection of responders for targeted interventions while minimizing overtreatment.

Blepharoconjunctivitis is an ophthalmic disease that combines the features of blepharitis and conjunctivitis. It is characterized by inflammation of the eyelid margin (blepharitis) and the surrounding conjunctiva (conjunctivitis). It is closely related to blepharitis and can be considered to be a mature form of blepharitis. If blepharitis is left unmanaged in the initial stages, the inflammation progresses to affect the nearby conjunctiva resulting in blepharoconjunctivitis. Several classification systems have been proposed to describe the condition based on etiology, clinical features, anatomy, and standardized photo grading scales.[1][2][3][4] The majority of cases in the United States are classified using the American Academy of Ophthalmology preferred practice patterns, which separate cases into anterior or posterior based on the anatomy affected.[5] Treatment is identical to blepharitis and focuses on symptom relief. Management is composed of lid hygiene and reduction of exposure to possible environmental triggers. Topical steroids, antibiotics, and antiseptics can also be used to manage the condition.[6][7]

Dupilumab-associated ocular surface disease (DAOSD) is one of the most common adverse events associated with dupilumab (an anti-interleukin-4-receptor-alpha monoclonal antibody) during the treatment of patients with atopic dermatitis (AD). However, it rarely occurs in patients with bronchial asthma or chronic rhinosinusitis with nasal polyps. Adequate understanding of DAOSD is important for proper diagnosis and appropriate ophthalmic intervention. The aim of this review was to summarize and discuss the clinical characteristics and management of DAOSD in Japan. The pathogenesis of DAOSD can be explained by the dry eye disease, upregulated T helper 17 and 22 cells, and Demodex theories. The main symptoms of DAOSD are irritation/pain, redness, pruritus, discharge, and light sensitivity. Patients with AD and DAOSD as an adverse event develop various types of ocular surface disease, including blepharitis, blepharoconjunctivitis, conjunctivitis, keratoconjunctivitis, and keratitis. In ophthalmologic practice, to diagnose and treat DAOSD, physicians must understand the condition of the patient, make a differential diagnosis of conjunctivitis, determine concurrent dry eye, and assess DAOSD severity. Red flags for ophthalmologic intervention have been reported by organizations and institutions in various countries, which have highlighted the need for appropriate ophthalmologic intervention. Treatment of DAOSD involves topical treatments with artificial tears, antiallergic drugs, corticosteroids, and immunosuppressive drugs. In conclusion, patients with severe DAOSD require ophthalmologic intervention, and clinical collaboration between ophthalmologists and dermatologists is crucial for patients with AD during dupilumab treatment. This review can assist ophthalmologists in their daily practice and in their management of patients with DAOSD.

Mpox is a reemerging zoonotic viral disease that has been declared a public health emergency. Ocular symptoms of mpox include pain, redness, tearing, discharge, swelling, and vision impairment. This report describes two cases of mpox with ocular involvement in Indonesia, where the patients had a history of multiple male partners (men who have sex with men (MSM)), human immunodeficiency virus (HIV), and tuberculosis (TB). The first case was a 28-year-old male patient with multiple scabs, including in the eye area, shown as right-eye blepharoconjunctivitis. Despite treatment with tecovirimat, he died from respiratory failure. The second case involved a 25-year-old male patient with similar symptoms and blepharoconjunctivitis in both eyes. He did not receive tecovirimat and also died from respiratory failure. Mpox can severely affect organs, including the eyes. The risk of mpox fatality increases with HIV and TB co-infection. Early recognition of the disease signs may improve the prognosis.