Treatment of neurotrophic keratitis (NTK) remains one of the challenges in ophthalmology. This article presents a case of successful use of recombinant nerve growth factor in the treatment of NK in a child with ichthyosis follicularis, atrichia, and photophobia (IFAP syndrome), type 2. The child had blepharospasm and extensive corneal epithelial defects with superficial vascularization in both eyes since birth. Despite local trophic therapy, the erosions persisted. The child was diagnosed with the systemic condition «ichthyosis follicularis, atrichia, and photophobia (IFAP syndrome), type 2». Despite long-term trophic therapy, corneal epithelial defects in both eyes persisted. Due to the ineffectiveness of standard treatment, the patient was prescribed cenegermin drug. Complete epithelialization of the epithelial defects was observed by day 34 of specific neurotrophic therapy, and a reliable corneal pain response appeared during the cotton wisp test. Complete restoration of the epithelial layer and corneal sensitivity persisted two months after completion of the treatment course. The use of the drug cenegermin effectively restored the epithelium and corneal sensitivity in long-persisting corneal erosions in a child with ichthyosis follicularis, atrichia, and photophobia (IFAP syndrome).

Eye pain is a common presentation in outpatient, urgent care, and emergency settings. Causes range from benign to vision-threatening. Family physicians should promptly identify red-flag features that require urgent or emergent ophthalmology referral. A painful eye with vision loss, severe photophobia, proptosis, hyphema, or corneal ulceration is a medical emergency. Patient history should include onset, associated vision changes, contact lens use, trauma, chemical exposure, systemic symptoms, and rheumatologic disease. Physical examination should include evaluation of visual acuity (eg, using a Snellen or Rosenbaum chart), pupillary reactions, and extraocular movements. The eyes should be inspected for redness, discharge, and corneal lesions with fluorescein, if available. Findings of significant photophobia, anisocoria, dendritic corneal lesions, or restricted eye movement should prompt immediate referral. Common emergent causes of eye pain include acute angle-closure glaucoma, orbital cellulitis, infectious keratitis, scleritis, and anterior uveitis. An algorithmic approach that distinguishes urgent vs nonurgent etiologies and ophthalmic vs nonophthalmic causes of eye pain can direct next steps.

Dry eye disease (DED) can lead to severe eye discomfort, which manifests as dryness, pain and decreased vision, and significantly affects daily life. This study elucidated the effects of electroacupuncture (EA) intervention on DED and clarified its potential mechanisms through changes in lacrimal gland lipid metabolism and inflammation. A DED mouse model was established by repeated subcutaneous injections of scopolamine hydrobromide, followed by EA intervention. The therapeutic effects of EA intervention on DED were determined based on tear secretion volume (n = 10), corneal fluorescein staining scores (n = 10), corneal stromal (CS) damage (n = 6), and changes in corneal and lacrimal gland morphology (n = 10). Mechanistic endpoints included lacrimal gland lipidomic profiling by ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) (n = 6) and assessment of IL-1β and IL-18 expression by immunohistochemistry (n = 6), western blotting (n = 3) and qRT-PCR (n = 6). EA increased tear secretion, reduced corneal fluorescein staining and ameliorated CS and lacrimal gland pathological alterations. Lipidomic analysis identified 81 metabolites, and Kyoto Encyclopaedia of Genes and Genomes (KEGG) enrichment analysis highlighted arachidonic acid metabolism and inflammation-related pathways. EA reduced arachidonic acid and several downstream pro-inflammatory metabolites while partially restoring omega-3 polyunsaturated fatty acids (PUFAs) and their derivatives. EA also reduced lacrimal gland IL-1β and IL-18 expression at the protein and mRNA levels. These findings suggest that EA may ameliorate scopolamine-induced DED, at least in part, through modulation of lacrimal gland lipid homeostasis and suppression of inflammatory responses.

There are significant knowledge gaps regarding the burden and clinical progression of ocular manifestations of mpox in Nigeria and worldwide. Here, we report two laboratory-confirmed mpox cases among young male adults with distinct ocular mpox presentations at two tertiary hospitals in southern Nigeria during the 2022 and 2024 global outbreaks. The first patient, a 28-year-old man, presented at the Alex Ekwueme Federal University Teaching Hospital in Abakaliki with a vesiculopustular rash on his nasal bridge and right lower eyelid, along with redness, pain, and itching. He subsequently developed corneal ulcers and vision problems after discharge, necessitating an ophthalmology review. The second case involved a 44-year-old man with advanced HIV, who presented with widespread vesiculo-pustular eruptions, including characteristic periorbital and orbital rashes. He presented with widespread vesiculo-pustular skin eruptions, including characteristic rashes around the periorbital and orbital areas. His condition deteriorated rapidly, leading to his death after seven days of hospitalisation. Consistent with guidance from the Nigeria Center for Disease Control and Prevention, lesional skin swabs from both patients were sent to the National Reference Laboratory in Abuja for quantitative polymerase chain reaction (qPCR), which tested positive for the monkeypox virus. Supportive care included antibiotics, antivirals, intravenous fluids, nutritional support, and skin care, as no specific mpox treatments were available at that time. Ocular disease has emerged as an increasingly common yet underreported manifestation of mpox in Nigeria since the 2022 global outbreak. Ophthalmologists should be part of the multidisciplinary team of specialists caring for mpox patients with ocular manifestations. Ongoing surveillance and research are vital to better understand eye-related complications and to improve the prevention and treatment of ocular symptoms, thereby preventing significant vision loss.

SETD5-related neurodevelopmental disorder is a rare genetic condition caused by a mutation in the SETD5 gene, which has previously been shown to cause intellectual disability (ID) along with dysmorphic facies, behavioral difficulties, congenital heart defects, and developmental delays. This report describes an eight-year-old patient with known SETD5 and inflammatory conditions who presented for evaluation of severe headaches consistent with migraines. This patient had associated photophobia and nausea, as well as pain around the eye that was severe enough to awaken him and was only relieved with rizatriptan. To our knowledge, migraine headaches have not previously been described in association with SETD5-related neurodevelopmental disorder. We hope that by sharing this patient's presentation and medical history, this report will broaden the clinical spectrum of SETD5 and its implications.

Invasive pneumococcal disease (IPD) is a life-threatening infection caused by Streptococcus pneumoniae, particularly in immunocompromised individuals, such as those with asplenia. Although pneumococcal vaccination has reduced the incidence of vaccine-covered serotypes, non-vaccine serotypes, including serotype 23B, have emerged as the predominant cause of IPD. This case report describes a 67-year-old woman with asplenia who developed IPD caused by multidrug-resistant Streptococcus pneumoniae serotype 23B, which led to meningitis, septic arthritis, and endophthalmitis. The patient, who had declined pneumococcal vaccination after her splenectomy, presented with fever, pain in her left hip and right shoulder, and visual issues. The diagnosis confirmed S. pneumoniae serotype 23B, resistant to multiple antibiotics. The treatment involved a combination of vancomycin, ceftriaxone, and rifampicin, followed by vitrectomy for the eye infection. Despite severe complications, including worsening vision, the patient's vision in the right eye improved after surgery, and the joint pain subsided with long-term antibiotic therapy. This case underscores the challenges posed by non-vaccine S. pneumoniae serotypes, particularly in asplenic patients. Currently, we can use the 21-valent pneumococcal conjugate vaccine (PCV21), which includes the 23B serotype. Vaccination and early recognition, combined with a multidisciplinary treatment approach involving both antimicrobial therapy and surgical intervention, are crucial for improving the outcomes of patients with severe IPD.

A 12-year-old girl presented with pain, swelling, and decreased vision in the left eye of 1-month duration. She had a significant history of left Wilms' tumor treated with left radical nephrectomy and chemotherapy at three years of age. Ocular examination revealed massive left proptosis, inferior globe dystopia, visual acuity of 20/160, ptosis, conjunctival chemosis, and corneal exposure changes. Orbital magnetic resonance imaging revealed a well-circumscribed T1-hypo and T2-hyperintense tumor in the superotemporal orbit with marked contrast enhancement. An excisional biopsy was performed, and histopathology was consistent with embryonal rhabdomyosarcoma. Genetic counseling was undertaken in view of multiple malignancies. Whole-exome sequencing identified a likely pathogenic null variant in the TRIP13 (c.998_999delCT, p.Ser333Leufs *30) gene, suggesting a diagnosis of mosaic variegated aneuploidy syndrome 3. Systemic surveillance showed no metastatic lesions. Adjuvant chemoradiotherapy was advised. Mosaic variegated aneuploidy syndrome can be associated with multiple malignancies, including Wilms' tumor and orbital rhabdomyosarcoma.

Syphilis can present with diverse ocular manifestations, including optic nerve and retinal involvement, often mimicking inflammatory or demyelinating disorders. In patients with pre-existing demyelinating conditions, new visual symptoms are frequently attributed to demyelination, which may delay recognition of coexisting syphilitic eye disease. We report a man in his 40s with relapsing-remitting multiple sclerosis who developed sequential central scotomas without pain on eye movements or dyschromatopsia. Examination revealed bilateral vitreous cells, and optical coherence tomography (OCT) showed ellipsoid zone disruption. Serologic testing demonstrated a reactive rapid plasma reagin titre of 1:64, confirming syphilitic chorioretinopathy. Treatment with intravenous penicillin led to marked visual improvement and restoration of the ellipsoid zone on OCT. This underscores the need to consider syphilis in the differential diagnosis of optic neuritis, even in patients with known demyelinating disease, and highlights the value of thorough ophthalmic evaluation and OCT imaging in such presentations.