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.

Adult-onset vitelliform macular dystrophy (AVMD) is a relatively uncommon macular pattern dystrophy characterized by bilateral, symmetric, yellowish subretinal foveal lesions presenting in the fourth to sixth decades of life. It is frequently misdiagnosed as age-related macular degeneration or Best vitelliform macular dystrophy, making accurate diagnosis through multimodal imaging essential. We report a case of a 51-year-old male laundry worker who presented with bilateral gradual visual impairment and difficulty with near vision for 1 month. Best-corrected visual acuity was 6/6 in the right eye, whereas in the left eye, it was 6/36p-NI with appropriate correction. Anterior segment examination revealed bilateral posterior subcapsular cataracts and seborrheic blepharitis. Dilated fundus examination demonstrated multiple discrete yellowish subretinal deposits at the fovea in the right eye and a single, elevated, circular vitelliform lesion at the center of the macula in the left eye, with absent foveal reflex bilaterally. Fundus autofluorescence imaging confirmed focal hyperautofluorescence corresponding to the vitelliform deposits bilaterally. Structural optical coherence tomography (OCT) revealed dome-shaped subretinal hyperreflective material between the retinal pigment epithelium and photoreceptor layer in both eyes, consistent with Stage II vitelliform disease in the left eye and an earlier stage in the right eye. OCT angiography excluded choroidal neovascularization in both eyes. Karyotype report and Sanger sequencing show no chromosomal abnormality. A diagnosis of AVMD was established based on clinical and multimodal imaging findings. This case underscores the diagnostic value of multimodal imaging in establishing an accurate diagnosis of AVMD, a condition that carries a generally favorable prognosis when identified early and monitored appropriately. Clinician awareness of AVMD and its distinguishing imaging characteristics is critical to avoid misdiagnosis and ensure timely patient counseling and surveillance.

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.