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.

BACKGROUND Pyoderma gangrenosum (PG) involving the eyelid is rare and can closely mimic other differential diagnoses, posing a diagnostic challenge. This case highlights the diagnostic approach and management of pyoderma gangrenosum-related eyelid lesions. CASE REPORT A 29-year-old man with a history of ulcerative colitis developed a persistent ulcerative lesion on his left upper eyelid, which failed to respond to conventional treatment for chalazion. Examination revealed a pinkish-yellow ulcerative lesion with ill-defined borders, causing distortion of the eyelid margin contour. Due to the potential for malignancy or atypical inflammatory disease, an incisional biopsy was performed. Infectious, rheumatologic, and vasculitis workup results were negative. Histopathological findings were consistent with a diagnosis of eyelid pyoderma gangrenosum. Initial treatment with intralesional triamcinolone resulted in limited improvement. In collaboration with the patient's gastroenterologist, the biologic immunomodulator ustekinumab was administered, leading to a substantial reduction in lesion size. To our knowledge, this represents the first reported case of eyelid pyoderma gangrenosum successfully treated with ustekinumab. At the 3-month follow-up, the eyelid lesion demonstrated considerable improvement. The patient remained stable without recurrences during 1 year of follow-up. CONCLUSIONS Pyoderma gangrenosum is a rare and aggressive condition that should be considered in the differential diagnosis of any ulcerative eyelid lesion. Given the diagnostic difficulty, management should focus on controlling the underlying systemic disease in collaboration with a gastroenterologist. Early diagnosis and appropriate management are crucial to prevent facial disfigurement and the need for complex eyelid reconstruction.

This report describes the case of a four-year-old girl with idiopathic facial aseptic granuloma (IFAG) who developed persistent, treatment-resistant eyelid and facial inflammation despite multiple courses of antibiotics and corticosteroids. Her presentation included recurrent hordeola, severe blepharitis, and a cheek nodule, with a clinical picture more consistent with IFAG than pilomatrixoma despite histologic evidence of the latter. Standard therapies provided only transient benefit and were limited by systemic side effects. Initiation of topical tacrolimus 0.03% ointment led to rapid and sustained improvement in redness, irritation, and nodularity. This case highlights topical tacrolimus as a promising non-steroidal option for children with prolonged or refractory IFAG.

Extraocular disorders and their surgical management can significantly influence corneal astigmatism and higher-order aberrations (HOAs). This review aimed to evaluate the relationship between extraocular conditions, their surgical correction, and subsequent changes in corneal astigmatism and HOAs. A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science, including studies published between 1992 and 2024. Search terms included astigmatism, eyelid surgery, thyroid eye disease (TED), orbital decompression, blepharoplasty, chalazion, dermatochalasis, ptosis, pterygium, scleral buckle, and HOAs. The reviewed literature demonstrates that a wide spectrum of extraocular disorders (such as ptosis, dermatochalasis, TED, chalazion, and pterygium) are associated with clinically significant changes in corneal astigmatism and HOAs. These alterations are affected by factors including lesion size, anatomical location, and the type of surgical intervention. For instance, ptosis surgery may either reduce or induce astigmatism depending on patient age and surgical technique, while chalazion excision and pterygium removal frequently lead to meaningful reductions in astigmatism and HOAs, particularly in cases involving larger lesions. The timing of postoperative evaluation and surgical approach plays a critical role in the magnitude and persistence of these optical changes. Awareness of the impact of extraocular diseases and their surgical treatment on corneal astigmatism and HOAs is essential for accurate interpretation of refractive changes, postoperative follow-up, and optimal patient management.

Sebaceous glands (SGs) and their specialized subtype, Meibomian glands (MGs), play essential roles in skin and ocular surface homeostasis by producing lipids that maintain barrier integrity and stabilize the tear film. Dysregulation of SG and MG biology contributes to a spectrum of disorders, ranging from benign hyperplasia to sebaceous carcinoma and age-related MG dysfunction. Accumulating evidence highlights the importance of epigenetic regulation, including histone modifications, DNA methylation, and non-coding RNAs (ncRNAs), in controlling SG and MG development, homeostasis, and disease susceptibility. Notably, histone modifiers and ncRNAs modulate acinar differentiation, lipid synthesis, and progenitor cell function. Despite these advances, many epigenetic mechanisms, such as histone lactylation, sumoylation, and phosphorylation, remain underexplored, and several common SG/MG disorders, including chalazion and seborrhea, lack mechanistic studies at the epigenetic level. This review synthesizes current knowledge on SG and MG biology, emphasizing epigenetic regulation, and highlights critical gaps to guide future research aimed at improving the understanding and treatment of SG- and MG-related disorders.