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.

Demodex mites, particularly Demodex folliculorum and Demodex brevis, are common ectoparasites residing in human pilosebaceous units, often implicated in dermatological and ocular conditions such as rosacea, blepharitis, and demodicosis. Conventional treatments include topical acaricides such as ivermectin, permethrin, and metronidazole; however, these agents may be associated with limited efficacy, resistance, and adverse effects. Consequently, there has been growing scientific interest in exploring alternative therapies derived from natural sources, particularly essential oils and herbal extracts with known acaricidal, anti-inflammatory, and antimicrobial properties. The goal of this review was to investigate the effects of herbal extracts and essential oils on Demodex spp. Mites in skin and hair, as well as how these parasites operate and what impact they have on people's health. Demodex parasites are small arthropods that reside on the outer surface of the skin and often have no specific clinical symptoms. The main cause of disease in humans is two types of Demodex mites, Demodex folliculorum and brevis. Currently, chemical drugs that target Demodex usually have side effects and low efficacy. However, research has shown that plant extracts and essential oils such as tea tree oil have acceptable effects on the treatment of Demodex parasites and have fewer side effects. Therefore, applying these techniques may be a more suitable choice for treating demodicosis.

Feline ocular diseases can cause irreversible vision loss if they are not detected early. However, early diagnosis is often difficult. This is due to limited access to veterinary ophthalmology services and the challenge of distinguishing between visually similar eye conditions. Illumination changes, glare, and strong visual similarity among diseases substantially limit the performance of conventional RGB-based classification models. This paper proposes the Color Space Fusion Network (CSF-Net), an attention-guided color interaction framework for robust feline ocular disease classification in real-world environments.

Blepharitis is a chronic inflammation of the eyelid margin that is mediated by the immune system. It is one of the common ocular surface diseases and often leads to serious sequelae that threaten vision, such as dry eye syndrome due to insufficient tear secretion, corneal neovascularization, and stubborn chalazion. Elucidating its precise etiology is therefore imperative. Emerging high-throughput sequencing and metagenomic analyses have unveiled a quantitative and qualitative disruption of the periocular microbiome (dysbiosis), characterized by the expansion of specific bacterial species such as Staphylococcus aureus, coupled with episodic blooms of Demodex. These perturbations are no longer considered epiphenomena. In this review, we reveal the possible mechanisms of the role of blepharitis and microbiota dysbiosis.

Demodex blepharitis is a chronic inflammatory ocular condition caused by Demodex mite infestation of the eyelid that can negatively impact quality of life. Currently, lotilaner ophthalmic solution 0.25% is the only FDA-approved treatment for Demodex blepharitis. The Demodex Expert Panel on Treatment and Eyelid Health has established consensus that lotilaner ophthalmic solution 0.25% should be considered the preferred first-line treatment for Demodex blepharitis. We report a patient who presented with collarettes, the pathognomonic sign of Demodex blepharitis, meibomian gland dysfunction, and poor visual acuity. The patient also had a history of neovascular age-related macular degeneration. Consistent with the Demodex Expert Panel on Treatment and Eyelid Health consensus recommendations, the patient was treated with lotilaner ophthalmic solution 0.25%, lid scrubs, and warm compresses. At the 2-month follow-up, collarettes had resolved, and signs of meibomian gland dysfunction had improved. This case supports the Demodex Expert Panel on Treatment and Eyelid Health recommendation that lotilaner ophthalmic solution 0.25% should be considered the preferred first-line treatment for Demodex blepharitis.

A 19-year-old male undergoing systemic isotretinoin therapy presented with bilateral corneal nodules resembling Salzmann nodular degeneration (SND). He had no prior ocular comorbidities and reported mild itching. Slitlamp examination revealed inflammatory nodules with pannus and blepharitis; optical coherence tomography (OCT) confirmed no stromal involvement. Systemic retinoid therapy was discontinued, and topical antiinflammatory treatment initiated. Despite transient visual decline, the patient improved over six months, with resolution of symptoms and stabilization of the corneal lesions. The temporal relationship between isotretinoin use and lesion onset, in the absence of other risk factors, suggests a possible association between systemic retinoids and SND-like pathology. This case highlights the importance of ophthalmologic monitoring in patients on retinoid therapy and raises awareness of potential corneal complications.