Vernal keratoconjunctivitis (VKC) is a chronic, seasonal, recurrent, bilateral allergic inflammatory disease that predominantly affects children, severely impacting patients' quality of life. The early diagnosis rate of VKC in Chinese children is relatively low, treatment regimens vary, and clinical efficacy is difficult to guarantee. To guide the related clinical practice, the Cornea Group of Ophthalmology Branch of Chinese Medical Association, together with the Chinese Association for Pediatric Ophthalmology and Strabismus, developed expert consensus recommendations for the diagnosis and treatment of pediatric VKC. These recommendations were formulated by integrating evidence-based medical research results from both domestic and international sources and expert clinical experience, and using standardized guideline and consensus development methods.

Transfusion-related acute lung injury (TRALI) is a leading cause of transfusion-associated morbidity and mortality. Posterior reversible encephalopathy syndrome (PRES) following transfusion is uncommon, and its concurrent occurrence with TRALI has rarely been described in the literature. We report a 65-year-old male with ascending colon carcinoma status post right hemicolectomy on adjuvant chemotherapy who developed acute hypoxemia and bilateral pulmonary infiltrates within 3 hours of packed red blood cell transfusion, consistent with TRALI. He subsequently developed acute neuropsychiatric manifestations, including agitation, headache, visual disturbances, abnormal behavior, nystagmoid eye movements, and gaze deviation. Magnetic resonance imaging demonstrated bilateral frontoparietal vasogenic edema without diffusion restriction, consistent with PRES. Both pulmonary and neurological abnormalities resolved substantially on follow-up. No pulmonary or neurological deficits were detected in sequential monthly follow-ups. Alternative causes, including transfusion-associated circulatory overload, sepsis-related acute respiratory distress syndrome, and sepsis-associated encephalopathy, were considered and are discussed. This case highlights the importance of recognizing rare, overlapping pulmonary and neurological transfusion complications and considering confounding illness in their diagnosis.

Septo-optic dysplasia (SOD) is a heterogeneous neurodevelopmental disorder classically defined by optic nerve hypoplasia, hypothalamo-pituitary dysfunction, and midline brain abnormalities, although the full triad is not consistently present. This review synthesises current evidence on the developmental, endocrine, ophthalmic, and neuroradiological dimensions of the SOD/optic nerve hypoplasia spectrum. Shared embryological origins of the optic pathways, hypothalamus, and pituitary, together with disruption of inductive signalling pathways and pathogenic variants in developmental regulators including SOX2, HESX1, SOX3, and OTX2, provide a mechanistic basis for combined ocular and pituitary phenotypes. Clinically, affected children may present with nystagmus, strabismus, visual impairment, neonatal hypoglycaemia, or evolving pituitary hormone deficiencies, and remain at risk of neurodevelopmental morbidity. Neuroradiological studies have expanded the phenotype beyond classical midline defects to include malformations of cortical development and SOD-plus presentations. Current evidence supports longitudinal endocrine surveillance, detailed ophthalmic assessment, and multidisciplinary care, including timely hormone replacement and developmental support where indicated.

Disorders of craniofacial muscles (CFM) frequently arise from various conditions and injuries affecting the central and peripheral nervous systems, as well as from neurosurgical, reconstructive, and cosmetic interventions. The principal clinical manifestations include facial asymmetry, lagophthalmos, paralytic strabismus, synkinesis, contractures, trismus, bruxism, temporomandibular joint dysfunction, chronic facial pain, and sialorrhea. Such disorders not only restrict daily functioning but also lead to significant psychosocial maladjustment, a decline in quality of life, and increased disability among affected individuals. Despite the high prevalence of CFM dysfunction, contemporary methods for the medical rehabilitation of patients remain inconsistent, with poor regulation governing continuity among the various stages of care. This paper posits the establishment of «facial rehabilitation» as a distinct interdisciplinary approach within medical rehabilitation, integrated into the established three-stage medical rehabilitation framework in the Russian Federation. A thorough review of current literature and pertinent Russian regulatory documents has been conducted. The objectives of facial rehabilitation across the first, second, and third stages are analyzed, along with the role of botulinum therapy in comprehensive rehabilitation programs aimed at restoring impaired functions. The potential of this method for a wide range of functional, structural, and autonomic disorders of the face is considered, given the multifaceted mechanisms of action of botulinum toxin type A (BTA), including muscle-relaxant, antinociceptive, neuromodulatory, and anti-inflammatory effects. The authors present their own clinical experience demonstrating the effective use of botulinum therapy to treat trismus, paralytic strabismus, lagophthalmos, and pronounced facial asymmetry in patients with complications from neurological conditions and injuries. The findings underscore the efficacy of integrating botulinum therapy into three-stage medical rehabilitation programs, highlighting its role in preventing complications and enhancing rehabilitation potential and quality of life for patients.

To evaluate dynamic intraocular microvascular changes in vascular paralytic strabismus using optical coherence tomography angiography (OCTA) and choroidal vascularity index (CVI), and to assess their reversibility after clinical recovery. In this prospective study, 31 patients with acute-onset vascular paralytic strabismus involving the third, fourth, or sixth cranial nerve were enrolled. OCTA and enhanced depth imaging (EDI)-OCT were performed during the paralytic phase and after full recovery. Parameters included vessel density (VD) in the superficial (SCP) and deep capillary plexuses (DCP), foveal avascular zone (FAZ), choriocapillaris flow, CVI and peripapillary vessel density (ppVD). Inter-eye and inter-phase differences were analysed. Statistical analysis was performed using generalised estimating equations (GEE) to account for within-subject correlations between eyes. During the paralysis phase, the affected eyes showed significantly reduced VD in the SCP across all macular regions, while changes in the DCP were limited to the fovea (p < .001). The FAZ area was larger (p = .012), and CVI was lower (p < .001) in the affected eye. After clinical recovery, SCP VD, choriocapillaris flow, and CVI in the previously affected eyes increased significantly, while FAZ and non-flow area decreased (p < .001 for both). Intradisc ppVD also improved (p = .048). Retinal and choroidal thickness remained stable. Vascular paralytic strabismus causes reversible ischaemic alterations, primarily in the macular SCP and choroid. These findings support a functional vascular disturbance rather than structural damage. This is the first study to evaluate the CVI in this condition, highlighting the utility of OCTA and EDI-OCT as noninvasive tools for monitoring dynamic ocular perfusion alterations.

Diplopia in thyroid eye disease (TED) results from restrictive myopathy and can be disabling. Teprotumumab, an insulin-like growth factor-1 (IGF-1) antagonist, reduces proptosis and improves diplopia as measured by a subjective Gorman diplopia score without assessing ocular misalignment. This study evaluated whether there was observed variability between subjective versus objective measures of diplopia assessment in patients with TED treated with teprotumumab. This retrospective case series included patients with TED-related diplopia treated with teprotumumab at a single institution. Gorman diplopia scores and strabismus measurements in primary and cardinal gaze positions were recorded before and after treatment. Patients without diplopia, with unrelated strabismus, or with <3 months of post-treatment follow-up were excluded. The primary endpoint was change in ocular alignment and Gorman score before and after teprotumumab and the secondary endpoint was examining the difference between the two outcomes of diplopia assessment. Of 67 patients treated, 17 met inclusion criteria. Teprotumumab improved ocular alignment in 71% (12/17) and Gorman score in 59% (10/17). Changes in alignment and Gorman score were not in alignment in 41% (7/17): 12% (2/17) showed Gorman improvement despite worsened alignment, while 30% (5/17) had alignment improvement without change in Gorman score. Teprotumumab improves both ocular alignment and diplopia in most TED patients; however, differences were observed between subjective and objective outcome measures. Validated tools are needed to assess therapeutic outcomes more accurately in TED-related strabismus.