Herpes simplex virus type 1 (HSV-1) corneal infection triggers an immunopathological response and corneal neovascularization leading to vision impairment. Thrombospondin-1 (TSP-1) is a matricellular protein shown to regulate inflammatory processes and vascularization in the cornea. The purpose of this study was to determine if loss of TSP-1 alters the pathology of HSV-1 keratitis. The recombinant virus INV-2C or the low passage orolabial HSV-1 isolate, Ikey, were administered to scarified corneas of 8-week-old Thbs1-/- and control C57BL/6J mice. Blepharitis, corneal neovascularization, corneal clouding, weight loss, viral titers, and mortality were determined on multiple days post infection. Corneal nerve loss was evaluated on day 2 and day 7. Neutralizing antibody, T-cell responses, and infiltrating cells in the aqueous and vitreous humors were quantified. There was no significant difference between Thbs1-/- and C57BL/6J control mice when comparing any corneal disease outcome with either virus. Severe pan-uveitis developed in both C57BL/6J and Thbs1-/- mice infected with the Ikey strain of virus. There were no significant differences in antibodies to HSV or in the number of HSV-1 specific IFN-g secreting T-cells in the spleen between C57BL/6 or TSP-1-/- mice. The lack of TSP-1 did not affect the severity of corneal disease, immune responses to HSV-1, or sensory nerve loss suggesting either TSP-1 functions are not involved in HSV-1 pathogenesis or that other members of the TSP family can substitute for the loss of TSP-1.

Blepharitis and meibomian gland dysfunction (MGD) commonly cause ocular surface symptoms, but comparative evidence for commonly used eyelid-cleansing strategies remains limited. We compared the 4-week efficacy of preformulated eyelid cleansing wipes, hypochlorous acid-assisted cleansing, and saline-assisted cleansing in adults with blepharitis-associated ocular surface disease. In this single-center, randomized, assessor-masked, parallel-group trial, adults aged 18-70 years were assigned to one of three cleansing interventions for 4 weeks. The primary endpoint was the baseline-adjusted Week 4 visual analog scale (VAS) score for the selected study eye in the full analysis set. Pairwise comparisons were performed only after a significant overall test, with Holm adjustment. Seventy-two participants were randomized; 64 were included in the full analysis set, and 59 had observed Week 4 VAS data. The overall between-group difference in baseline-adjusted Week 4 VAS was significant (P = 0.007). Adjusted mean Week 4 VAS values were 27.47 (95% CI, 22.18-32.76) in the wipe group, 33.16 (95% CI, 27.80-38.51) in the hypochlorous acid group, and 40.83 (95% CI, 34.93-46.72) in the saline group. The wipe group had lower Week 4 VAS than the saline group (adjusted difference, - 13.35; 95% CI, - 21.51 to - 5.20; Holm-adjusted P = 0.005). No other pairwise comparison remained significant. Between-group differences in Schirmer test result, corneal fluorescein staining, and MGD expressibility were interpreted as supportive secondary findings. In this single-center, assessor-masked randomized trial, preformulated eyelid cleansing wipes were associated with a lower baseline-adjusted Week 4 VAS symptom score than saline-assisted mechanical lid cleansing. Confirmatory superiority over hypochlorous acid was not established, and sign-based secondary findings should be interpreted as supportive.

Psoriasis is a chronic immune-mediated skin disease that may be associated with ocular manifestations, most commonly uveitis, keratoconjunctivitis, and blepharitis. Strabismus has been rarely reported in association with psoriasis. We present a woman with longstanding psoriasis, who developed acquired intermittent alternating esotropia with diplopia; she was later diagnosed with psoriatic arthritis. This case describes an uncommon ocular finding occurring with psoriasis and underscores the importance of coordinated, multidisciplinary care when new ocular or systemic symptoms arise.

Anterior segment eye diseases significantly affect patients' quality of life (QoL) by impairing physical health, psychological well-being, social interactions, and economic stability. Conditions such as dry eye disease, blepharitis, conjunctivitis, keratoconus, keratitis, and corneal dystrophies cause chronic discomfort, visual disturbance, and emotional distress, leading to reduced daily functioning and work productivity. Other disorders like chalazion, trichiasis, ptosis, strabismus, and thyroid eye disease entail a psychological burden by affecting appearance and social confidence. This narrative review comprehensively examines the multidimensional impact of anterior segment diseases on QoL. A systematic literature search was conducted in PubMed, Scopus, Web of Science, and Google Scholar for English-language articles published between December 1997 and February 2025. Using relevant keywords and Boolean operators, we initially identified 854 articles. Following duplicate removal and screening based on inclusion and exclusion criteria focused on QoL-related outcomes in anterior segment diseases, we selected 72 high-quality studies for the review. This methodology ensured a thorough and focused analysis of the available evidence. Findings highlight the importance of addressing both clinical symptoms and psychosocial effects in management strategies. Future research should emphasize interventions that improve ocular function alongside overall well-being.

Chronic red eye is a prevalent presentation in both primary care and emergency settings. While most cases are self-limiting, recurrent or treatment-resistant episodes warrant systematic evaluation to exclude underlying chronic inflammatory conditions. We report the case of a 19-year-old female patient with a longstanding history of bilateral red eye associated with pain, photophobia, and epiphora, initially and repeatedly managed as infectious conjunctivitis in the emergency department (ED). Despite multiple antibiotic courses, symptoms persisted. Ophthalmologic evaluation ultimately revealed chronic anterior and posterior blepharitis with meibomian gland dysfunction, peripheral corneal infiltrates, and neovascularization (NV) - findings consistent with ocular rosacea. Notably, subtle cutaneous signs of rosacea were also identified on clinical examination, further supporting the diagnosis. Following targeted therapy with oral doxycycline 100 mg twice daily, topical corticosteroids (CSs), and ocular lubricants, the patient achieved significant clinical improvement. This case highlights the diagnostic pitfalls of recurrent red eye in primary care, the importance of recognizing chronic inflammatory ocular surface disease, and the value of timely ophthalmologic referral in preventing irreversible corneal complications.

Pediatric phlyctenular keratoconjunctivitis (PKC) is a common nodular inflammatory disorder characterized by the presence of phlyctenules, which are raised yellow-gray lesions on the conjunctiva or cornea. As an entity on the spectrum of disease of pediatric blepharokeratoconjunctivitis, PKC involves a dysregulated immune response focused on a type IV hypersensitivity reaction. PKC classically has an antigenic trigger from an infectious microbe and is frequently co-morbid with conditions such as rosacea, demodicosis, and blepharitis. Clinically, patients present with ocular irritation, and examination findings include both corneal and conjunctival pathology with the presence of phlyctenules. Complications can arise, including corneal scarring, neovascularization, ulceration, and even perforation. The management of PKC involves the treatment of underlying blepharitis, as well as inflammation control with anti-inflammatory antibiotics and topical steroids or topical immunomodulatory agents, such as cyclosporine A. Patients with ulceration may require topical antibiotics, while patients with perforation may require surgical intervention. PKC is a major cause of referrals to pediatric cornea specialists and has the ability to cause significant visual morbidity. Thus, early recognition and appropriate management of this condition are critical to prevent permanent visual impairment in the vulnerable pediatric population.