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.

Capnocytophaga canimorsus is a slow-growing, Gram-negative bacterium commonly found as a part of the normal oral flora of dogs and cats, and it is associated with severe systemic infections following dog bites, especially in immunocompromised patients. Although spondylodiscitis due to Capnocytophaga species has been reported in the literature, cases involving previously operated spinal segments are extremely rare. A 52-year-old woman working as a dog trainer presented with fever, headache, photophobia, and lumbar back pain. Her medical history included an L5-S1 hemilaminectomy performed 9-year prior to admission. Following an initial concern for meningitis, imaging studies revealed L4-L5 spondylodiscitis. Microbiological diagnosis was obtained through computed tomography-guided biopsy. Biopsy cultures isolated C. canimorsus after 72 h of anaerobic incubation, subsequently confirmed by MALDI-TOF mass spectrometry and 16S rRNA gene sequencing. The patient was successfully treated with amoxicillin/clavulanic acid, achieving complete resolution of symptoms. Hematogenous seeding, rather than direct surgical site contamination, should be emphasized in patients with a history of prior spinal surgery. Furthermore, C. canimorsus should be included in the differential diagnosis of spinal infections in patients with animal exposure, even in the absence of overt bite wounds.

A nine-year-old boy, the only child of non-consanguineous parents, presented with progressive bilateral visual impairment and corneal clouding since birth. Ocular examination showed bilateral epithelial-stromal corneal dystrophy associated with photophobia, blepharospasm, alternating esotropia, and nystagmus. Visual acuity was limited to light perception in both eyes, with normal intraocular pressure. Anterior segment optical coherence tomography (OCT) demonstrated diffuse epithelial-stromal thickening with hyperreflective anterior stroma. Flash electroretinography (ERG) was normal, while flash visual evoked potentials (VEP) revealed bilateral optic neuropathy. Systemic examination noted severe psychomotor impairment, hypotonia, and facial dysmorphism. Whole-exome sequencing identified a homozygous nonsense mutation in MCOLN1 (c.169C>T p.Arg57*), confirming mucolipidosis type IV. Mucolipidosis type IV is a rare autosomal-recessive lysosomal storage disorder combining ocular and neurological manifestations. In children with congenital corneal opacity and developmental delay, metabolic and genetic evaluation should be systematically pursued. Corneal transplantation is not recommended because of recurrence risk; management is supportive and multidisciplinary.

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.

BACKGROUND Glaucoma is a progressive optic neuropathy often associated with elevated intraocular pressure (IOP). Implantation of an Ahmed glaucoma valve (AGV), a silicone or polypropylene shunt tube, can regulate aqueous humor drainage through a filtering bleb and lower IOP. A rare postoperative complication of AGV implantation is giant bleb formation, which typically occurs early in the postoperative period and can require surgical revision if IOP becomes uncontrolled or if the bleb causes discomfort/cosmetic concerns. We describe a case of bilateral refractory steroid-induced glaucoma and delayed-onset giant bleb formation after AGV implantation, temporally associated with coronavirus disease 2019 (COVID-19). CASE REPORT A 39-year-old man with bilateral steroid-induced glaucoma presented for an unscheduled visit 3 years after AGV implantation in the left eye with complaints of photophobia and foreign body sensation. He also reported recent COVID-19 onset. Tonometry revealed elevated IOP in the left eye (50 mm Hg). Examination showed an enlarged superotemporal bleb overlying the Ahmed valve plate. Treatment comprising topical glaucoma medications and oral acetazolamide improved bleb appearance and stabilized IOP within 3 months. At the last follow-up, the patient remained stable, with well-controlled IOP in both eyes on 4 topical glaucoma agents (6 medications total) and oral acetazolamide. CONCLUSIONS This report describes delayed-onset giant bleb formation and pronounced IOP elevation coincident with COVID-19 onset several years after AGV implantation. Conservative medical management improved bleb appearance and IOP; long-term pressure control required maximal medical therapy. Clinicians should remain vigilant for persistent IOP elevation despite favorable bleb appearance, including after COVID-19 onset.

Chronic ocular surface pain (COSP) is a debilitating condition of the eye driven by nociceptive, nociplastic, and neuropathic mechanisms. While individual studies using functional neuroimaging techniques to investigate ocular pain exist, the full extent, methodologies, and cumulative findings of this body of literature have not been systematically synthesized. Using a systematic review approach, we identified 5 articles evaluating the use of functional neuroimaging in COSP patients from an initial pool of 643 unique studies. All studies used functional magnetic resonance imaging exclusively as their functional neuroimaging modality, and 4 included photophobia as a manifestation of COSP. Across the studies, there were a total of 107 adult patients enrolled, of whom 83 were cases (37.3% female) with active COSP/photophobia and 24 were controls (29.2% female). The results of the studies demonstrate that light robustly recruits trigeminocortical nociceptive networks (spinal trigeminal/brainstem, S1, insula, anterior midcingulate), with partial attenuation after interventions such as topical anesthesia, botulinum toxin, or FL-41 lenses. Mechanistically, photophobia may reflect convergence of melanopsin/intrinsically photosensitive retinal ganglion cells signaling with trigeminothalamic pathways, motivating brain-based biomarkers alongside surface metrics. The consistency in study design, imaging hardware, and analytical pipelines across the 5 primary articles facilitates direct comparison but also highlights current limitations in the broader generalizability and diversity of the field. Notably, the paucity of neurophysiological studies limits our mechanistic understanding of COSP in terms of neural oscillations that can be potential targets of neuromodulatory interventions.