Psychosocial stress detection via cost-effective means could prove a useful tool in the diagnosis of long-term stress experience and subsequent prevention of stress-related health disorders. Facial expressions are both part of and a relay for complex affective states, such as acute stress. In the current post-hoc study we investigated differences in facial activity between participants under acute psychosocial stress and in a stress-free control task. N = 126 adults either completed the Trier Social Stress Test (TSST) or a stress-free placebo TSST while being video recorded. Stress group participants also provided multiple samples of salivary cortisol, heart rate, heart rate variability and subjective stress. Facial activity was indexed via action unit (AU) activity on a frame-by-frame basis. We found that stress group participants showed significantly less facial activity across AU04 (brow lowerer), AU06 (cheek raiser), AU07 (eyelid tightener) and AU12 (lip corner puller) during the talk but not during the math block of the TSST. These group differences were not further explained by participant sex. These findings were corroborated by dynamic structural equation modeling of facial activity. Physiological and psychological stress reactivity, however, was not revealed to covary with facial behavior during evaluative stress. In conclusion, this study is another step towards stress detection via easy-to-implement and cost-effective means.

Contact lens wear in humans and mice is consistently associated with asymptomatic corneal parainflammation. Here, we tested the hypothesis that the corneal response to lens wear alone can function to protect it against bacterial adhesion enabled by superficial injury. One eye only of mT/mG-LysMcre mice (cell membranes red; Lyz2+ cells green) wore a contact lens for 4-6 days. After lens removal, mice were anesthetized and both corneas superficially-injured before bacterial inoculation with either a mouse eyelid commensal (Macrococcus epidermidis) or a corneal pathogen (Pseudomonas aeruginosa). Inoculation was repeated hourly for 4 hours under anesthesia before euthanasia. Enucleated eyes were fixed overnight, and adherent bacteria visualized using a universal 16S rRNA-targeted FISH probe (M. epidermidis) or Blue Fluorescent Protein (P. aeruginosa). Confocal imaging and Imaris software were used to quantify bacterial adhesion and location in the epithelium, and also the number, location and morphology of Lyz2+ cells. For both commensal and P. aeruginosa, prior lens wear resulted in reduced adhesion to the superficially-injured corneas (~46% and ~57% respectively). In both instances this correlated with increased numbers of corneal Lyz2+ cells. Other details differed for the two bacterial types. For the commensal, prior lens wear resulted in bacteria penetrating deeper into the epithelium versus contralateral eyes, with Lyz2+ cells extending their processes further into the epithelium and localizing closer to the cornea surface. For P. aeruginosa, prior lens wear resulted in adherent bacteria closer to the cornea surface, and Lyz2+ cells moving further away from it. Moreover, while overall Lyz2+ cell sphericity increased for P. aeruginosa with prior lens wear versus contralateral eyes, it showed no overall change for the commensal. Lyz2+ cell volume in the central cornea was decreased for P. aeruginosa with prior lens wear but increased for the commensal. Thus, corneal responses to prior lens wear can quantitively reduce bacterial adhesion to superficially-injured corneas correlating with a Lyz2+ cell response for both a commensal and a pathogen, with differences in details for the two bacterial types. How continued lens wear supersedes this protective response to promote P. aeruginosa infection pathogenesis remains to be determined, as does the relationship to the Lyz2+ cell response.

Merkel cell carcinoma (MCC) is a rare, aggressive neurocutaneous malignancy associated with ultraviolet damage, immunosuppression, and Merkel cell polyoma virus infection. Periocular MCC is uncommon but has high rates of local recurrence and metastasis and presents unique therapeutic challenges due to functional and cosmetic considerations. Immune checkpoint inhibitor (ICI) therapy has shown efficacy in systemic MCC; however, evidence for periocular use is limited to small case series and reports without consolidated evidence or consensus. Thus, this study summarizes and evaluates the effectiveness and safety of ICIs for periocular MCC. A systematic literature search across PubMed, Embase, and Web of Science was conducted according to PRISMA guidelines. Randomized and nonrandomized studies, case series, and case reports in English describing ICI use for periocular MCC were included. Non-human studies, non-periocular MCC, and reports without ICI treatment were excluded. Extracted data included patient demographics, tumor characteristics, treatment regimen, and patient outcomes. Seven studies reporting ten patients were included. Treatment regimens consisted of pembrolizumab (n = 6) and avelumab (n = 3), or both medications (n = 1). At a mean follow-up of 11.4 ± 9.0 months, nine patients had complete response (90%); only one patient developed subsequent distant progression despite local response. Patients with both localized periocular disease and metastatic involvement demonstrated favorable responses to ICI. Adverse effects were infrequent and typically mild; only one patient discontinued therapy due to adverse effects. ICIs may be an effective and well-tolerated treatment for local and advanced periocular MCC; however, larger, prospective studies are needed.

Background: Eyelid malignancies require accurate intraoperative margin control to achieve complete tumor excision while preserving the functional and aesthetic integrity of the periocular region. Mohs micrographic surgery (MMS) is widely regarded as the reference standard for margin-controlled excision, whereas frozen section-controlled excision (FSC) represents a reliable and widely used alternative in oculoplastic practice. In parallel, several emerging imaging technologies are being investigated to improve real-time tumor detection and surgical precision. Methods: A narrative review of the literature was conducted to summarize current evidence on intraoperative margin control in eyelid tumor surgery. The review focused on established surgical techniques, including MMS and FSC, as well as emerging imaging modalities such as fluorescence confocal microscopy, reflectance confocal microscopy, optical coherence tomography, line-field confocal optical coherence tomography, photoacoustic imaging, and artificial intelligence (AI)-assisted analysis. Results: MMS provides complete circumferential peripheral and deep margin assessment and remains the benchmark for high-risk, recurrent, and poorly defined periocular tumors, particularly basal cell carcinoma. FSC offers favorable oncologic outcomes, allows immediate reconstruction, and remains an effective option when MMS is not available. Emerging imaging modalities have shown promising diagnostic performance for tumor detection, presurgical mapping, and intraoperative support, particularly in basal cell carcinoma, although evidence in periocular tumors remains limited for most techniques. AI-assisted approaches have also demonstrated high accuracy in the interpretation of frozen sections and optical imaging data, suggesting potential to improve workflow efficiency and diagnostic consistency. Conclusions: MMS and FSC remain the current standards for intraoperative margin control in eyelid tumor surgery. Emerging imaging technologies and AI-based tools may further enhance surgical precision and tissue preservation, but most remain investigational in the periocular setting. Further prospective studies are needed to validate their clinical utility, define standardized workflows, and clarify their role alongside established histopathologic techniques.

BACKGROUND Oculomotor neuropathy represents a very small proportion of cranial nerve palsies in children. It may result from both congenital and acquired causes. Acquired causes include vasculopathies, inflammation, infections, and neoplasms. However, only a limited number of studies in adults and children have identified post-infectious isolated oculomotor neuropathy, and even fewer have investigated the therapeutic role of corticosteroids in its treatment. CASE REPORT A previously healthy 4-year-old Saudi boy presented to the emergency department with acute onset of substantial drooping of the left upper eyelid, diplopia, and subjective low-grade fever. There were no symptoms of increased intracranial pressure and no history of head trauma. Physical examination revealed complete left-sided oculomotor neuropathy and anisocoria, without involvement of other cranial nerves or additional focal findings. Neuroimaging (computed tomography, contrast-enhanced magnetic resonance imaging, magnetic resonance angiography, and magnetic resonance venography), cerebrospinal fluid analysis, and opening pressure assessment showed normal results. Other serological findings were unremarkable. No underlying etiology was identified, and a post-infectious immune-mediated process was suspected. Oral prednisolone was initiated at a dose of 2 mg/kg/day for 5 days, followed by a 5-day taper. Follow-up at 3 months demonstrated complete resolution. CONCLUSIONS This case of isolated unilateral oculomotor neuropathy after presumed infection demonstrated complete clinical recovery after a short course of oral corticosteroids. Although a causal relationship cannot be established, such treatment may be cautiously considered in children who present with acute oculomotor neuropathy and a possible post-infectious process after an extensive, inconclusive workup. Further studies are needed to confirm this observation.

To evaluate the accuracy, consistency, and efficiency of a novel digital measurement method for blepharoptosis grading utilizing iPhone photography and built-in markup tools, compared to the traditional ruler method. In this prospective, blinded methodological comparison study, 145 patients (185 eyes) with blepharoptosis were enrolled. Each patient underwent marginal reflex distance 1 (MRD1) measurement via both the traditional ruler method (control) and the iPhone method (experimental). The iPhone method involved capturing standardized photographs and performing measurements using the device's native markup feature. Agreement between methods was assessed using the Intraclass Correlation Coefficient (ICC) and Bland-Altman analysis. Grading consistency was evaluated using the Kappa statistic, and operational efficiency was compared via independent t-tests. The mean MRD1 values were 2.18 ± 0.94 mm (ruler) and 2.22 ± 0.89 mm (iPhone), with no statistically significant difference (P = .188). The 2 methods demonstrated excellent agreement, with an ICC of 0.968 (95% CI: 0.956-0.977). Bland-Altman analysis showed a mean bias of -0.04 mm, with 95% limits of agreement from -0.51 mm to 0.43 mm. Clinical grading consistency was almost perfect (Kappa = 0.892). The iPhone method was significantly more efficient, requiring less time than the traditional method (64.8 ± 18.7 s vs 86.5 ± 22.3 s, P < .001). The smartphone-based digital measurement method proves to be an accurate, reliable, and efficient alternative to the traditional ruler method for quantifying MRD1 and grading blepharoptosis. It demonstrates high agreement with conventional techniques while offering advantages in standardization, traceability, and operational workflow. This approach holds significant potential for enhancing diagnostic precision in clinical practice, particularly in outpatient and primary care settings.

The use of amniotic membrane (AM) in ophthalmology has evolved significantly since its first documented application in ocular surface reconstruction in the 1940s. Widespread clinical interest surged in the late 20th century following the development of improved processing and preservation methods. This comprehensive review covers the history, properties, and clinical applications of AM in ophthalmology. Derived from the innermost layer of the placenta, AM is composed of epithelium, a thick basement membrane and avascular stromal matrix, providing a biologic scaffold that supports epithelial cell migration and adhesion. AM possesses a unique combination of anti-inflammatory, anti-fibrotic, anti-angiogenic, and antimicrobial properties. It contains a rich array of cytokines, growth factors, and extracellular matrix proteins which modulate inflammation and promote tissue regeneration. Clinically, AM is widely used in the management of ocular surface disorders, including pterygium surgery, acute chemical burns, persistent epithelial defects, corneal ulcers, and limbal stem cell deficiency. It serves both as a biological bandage and as a substrate for epithelial growth. The integration of AM into ophthalmic practice has significantly enhanced outcomes in ocular surface healing and remains a cornerstone in the management of complex anterior segment pathologies. AM's applications in non-ocular surface procedures within ophthalmology are also rapidly expanding. Notably, AM has been employed in orbital reconstruction, eyelid surgery, glaucoma filtration surgery, strabismus surgery, and vitreoretinal surgery. These diverse applications along with active development of novel formulations highlight the versatility of AM. Ongoing research continues to explore its full potential and applications in the anterior and posterior segment and adnexa.