Pragnya Rao Donthineni

Purpose: To describe the clinical profile of allergic eye disease (AED) in adults and to compare clinical presentation and course based on the age-of-onset. Methods: This retrospective cross-sectional hospital-based study included 5030 adults (>21 years) presenting with AED to a tertiary eye care center from 2015 to 2022. Based on age of onset, patients were subgrouped as adult-onset (>21 years) or childhood-onset (≤21 years) groups. Data were collected using an electronic medical record system and analyzed appropriately. Results: Of the 5030 patients (54% males, median age 34 (interquartile range: 27–45) years), 4475 (89%) had adult-onset and 555 (11%) had childhood-onset AED. Although male preponderance was seen in the childhood-onset group, no gender differences were noted in the adult-onset group. Although vernal keratoconjunctivitis was the commonest allergy type in both groups, limbal involvement was greater in the childhood-onset group (45% vs. 16%, P < 0.0001). The most common comorbidities seen were keratoconus (14.05%), limbal stem cell deficiency (7.74%), and steroid-induced glaucoma (SIG; 6.66%) in the childhood-onset and ptosis (2.19%), keratoconus (1.87%), and SIG (1.29%) in the adult-onset group. Early age of onset of allergy was associated with higher risk of complications, with the childhood-onset group showing higher odds of keratoconus, limbal stem cell deficiency, and SIG (odds ratio: 4.5, 6.7, 10.4; P < 0.001) compared with the adult-onset group. Conclusions: This study explores AED in adults, revealing differences between adult-onset and childhood-onset allergies. Despite similarities in predominant type of allergy, the childhood-onset group showed higher rates of ocular morbidity, underscoring long-term impact of early-onset disease and the need for targeted research and timely age-stratified management.

Emerging evidence highlights the critical role of corneal nerves in the pathophysiology of dry eye disease (DED) and other related ocular surface disorders (OSDs). These conditions increasingly demonstrate neuropathic and neurotrophic components, wherein alterations in corneal nerve morphology and function contribute to symptomatology and disease progression. Recent advances in imaging and diagnostic modalities have enabled detailed, in vivo evaluation of corneal nerve architecture and sensory function, offering novel insights into underlying mechanisms and therapeutic responses. This review comprehensively examines current and emerging technologies for corneal nerve assessment, both structural and functional. The structural methods include in vivo confocal microscopy (IVCM), optical coherence tomography (OCT)-based nerve imaging (e.g., micro-OCT), and emerging technologies like multiphoton microscopy. The functional methods of corneal nerve assessment include advanced esthesiometers, quantitative sensory testing (QST), and functional magnetic resonance imaging (fMRI). The emerging technologies also include AI-driven analytical platforms that can be applied to both structural and functional methods. These various nerve assessment modalities can aid in delineating DED subtypes, selecting targeted treatments, monitoring nerve regeneration, and predicting treatment outcomes. By integrating structural and functional assessments, these technologies are reshaping the diagnosis, phenotyping, and management of DED and other related OSDs, paving the way for personalized therapeutic approaches.

Background/Objectives: Post-coronavirus syndrome (long-COVID) refers to a multi-systemic range of symptoms that follows acute SARS-CoV-3 infection. Long-COVID has been linked with autonomic neuropathy as well as dry-eye disease (DED), an umbrella term that includes a variety of ocular symptoms and signs. Despite these associations, little is known about the co-occurrence of DED and dysautonomia symptoms in individuals with long-COVID. This study aims to examine relationships between dysautonomia and ocular symptoms in a long-COVID patient population. Methods: Cross-sectional study of 162 veterans with long-COVID. The Composite Autonomic Symptom Score-31 (COMPASS-31) assessed dysautonomia symptoms, and the NASA lean test and heart-rate variability metrics captured dysautonomia signs. Dry-eye disease (DED) symptoms were measured with the 5-Item Dry-Eye Questionnaire (DEQ5) and the Ocular Surface Disease Index (OSDI), while ocular pain intensity and neuropathic pain descriptors were evaluated using a Numerical Rating Scale (NRS) and select questions from the Neuropathic Pain Symptom Inventory modified for the Eye (NPSI-Eye), respectively. Results: Most participants (78%) reported DED symptoms (DEQ5 ≥ 6). Nearly all COMPASS-31 domains were associated with DED symptoms, with the strongest correlation observed between the OSDI and pupillomotor scores (r = 0.67, p < 0.001). Among the autonomic signs, the strongest associations were observed between the change in systolic and diastolic blood pressure from baseline to 8 min and ocular pain triggered by temperature (r = −0.44 and r = −0.48, respectively, p < 0.01 for both). On linear regression analyses, pupillomotor and secretomotor symptoms remained positively associated with DED symptoms, while autonomic signs were most closely related to ocular pain metrics, with fluctuating blood pressure changes during orthostasis relating to neuropathic symptoms. Conclusions: DED symptoms, including ocular pain intensity, relate to autonomic symptoms in a long-COVID cohort. While associations with autonomic signs were less consistent, these data suggest that subtle autonomic variability relates to ocular pain in the long-COVID setting.

Purpose: Migratory Serpiginous Corneal Epitheliopathy (MSCE) is a rare condition characterized by migrating corneal epithelial lesions with a serpiginous or amoeboid-shaped appearance. Its etiology remains poorly understood, and the condition often presents a diagnostic and therapeutic challenge. Here, we report a case of a recurrent, unilateral MSCE-like lesion in a 25-year-old woman not responding to standard treatments, including repeated corneal debridement, bandage contact lens placement, and superficial keratectomy with postoperative slow tapering of steroids. Methods: Eventually, microbiological testing of corneal epithelial scrapings obtained during a repeat superficial keratectomy revealed the presence of HSV-1 on both immunofluorescence assay and polymerase chain reaction. Although histopathology did not show classical features of HSV, viral cytopathic effects like perinuclear haloes were noted in some epithelial cells. Results: Based on these findings, our patient was started on topical antiviral therapy (3% acyclovir eye ointment, 5 times daily for 1 month). This led to complete resolution of the lesion, with no recurrence at the last follow-up, 9 months after initiating topical antivirals. Conclusions: To our knowledge, this is the first reported case associating HSV to MSCE, emphasizing the importance of considering viral etiologies and microbiological evaluation, including virology in atypical, recurrent corneal epitheliopathies.

Meibomian gland dysfunction (MGD) constitutes the most common cause of dry eye disease (DED), where altering meibum or lipids result in tear film instability. This study compares structural and tear film changes induced by chemical cauterization (CC) and electrocauterization (EC) in establishing a rabbit model of obstructive MGD assessed using non-invasive tear film assessment and histology. Eighteen New Zealand white rabbits were subjected to CC (n = 9) using 1 M NaOH-soaked sponges or EC (n = 9) using electrocautery probes. Non-invasive tear film assessment including tear meniscus height, non-invasive tear film break-up time (NITBUT), and meibography were performed using keratography 5 M (Oculus, Germany) at days 7, 14, 30, 60, and 90 and structural changes were assessed by histopathological, IHC studies, and qPCR. Both groups showed similar clinical features, including increased lid margin vascularity, irregularity, and MG orifice plugging by day 30. NITBUT significantly decreased by day 30 and persisted at day 90 (CC: 9.50 ± 0.37, p = 0.002; EC: 8.34 ± 0.48, p = 0.008), indicating tear film instability. CS scores were higher at day 90, and average meiboscore was 2.0 ± 1.0 (CC, p = 0.03) and 1.7 ± 0.6 (EC, p < 0.01). Histopathology confirmed duct dilatation, inspissated secretions, and acinar atrophy. IHC showed decreased CK-14 expression. Gene expression for proliferation and lipid synthesis was similar between groups. In conclusion, this study demonstrates that CC and EC effectively induce obstructive MGD in rabbits, with measurable changes on non-invasive tear film assessments, meibography, and histology as seen in humans. Non-invasive assessments can provide standardized, objective metrics for studying DED in animal models and evaluating therapeutic interventions.

Purpose To study the clinical characteristics and treatment outcomes of ocular surface pseudoepitheliomatous hyperplasia (PEH) associated with chronic vernal keratoconjunctivitis (VKC). Methods This retrospective study includes 39 eyes of 32 patients with VKC induced PEH who presented from 2016–2022. A database search was conducted for diagnosis of PEH, and data on clinical features, imaging characteristics, and treatment were analyzed. Results Of the 32 patients, 11 (34%) were children and adolescents, 21 (66%) were adults. PEH was common in males (72%) and ocular surface squamous neoplasia (OSSN) was the commonest referral diagnosis (43.7%). Mean age at presentation was 26.62 ± 10.18 (range: 6–52) years. While history of VKC was present in 21 patients, 11 were diagnosed with VKC at the time of diagnosis of PEH. The mean base/largest diameter was 5.2 ± 1.67 mm. Anterior segment optical coherence tomography (AS-OCT) showed irregular hyper-reflective epithelium, epithelial dipping, and sub-epithelial hyper-reflective lesion with shadowing in all lesions. Of the 31 eyes that received medical therapy, 21 (67%) and 10 (32%) eyes showed complete and partial resolution respectively with median time to resolution of 3(IQR:2–4) months. Eight eyes that underwent surgical excision showed complete resolution and one developed partial limbal stem cell deficiency. Conclusion Ocular surface PEH is a manifestation of chronic VKC which closely mimics OSSN. Detailed history-taking, examination for signs of allergy, and AS-OCT imaging can distinguish it from OSSN. It responds well to medical therapy and should be considered first-line therapy before planning any surgical intervention.

Corneal perforations in eyes with dry eye disease (DED) are difficult to manage due to the interplay of several factors such as the unstable tear film, surface inflammation, and the underlying systemic disease affecting the wound healing process, and the eventual outcome. A careful preoperative examination is required to identify the underlying pathology, and status of ocular surface and adnexa, rule out microbial keratitis, and order appropriate systemic workup in addition to assessing the perforation itself. Several surgical options are available, which include tissue adhesives, multilayered amniotic membrane grafting (AMT), tenon patch graft (TPG), corneal patch graft (CPG), and penetrating keratoplasty (PK). The choice of procedure depends upon the size, location, and configuration of the perforation. In eyes with smaller perforations, tissue adhesives are effective treatment modalities, whereas AMT, TPG, and CPG are viable options in moderate-sized perforations. AMT and TPG are also preferable in cases where the placement of a bandage contact lens may be a challenge. Large perforations require a PK, with additional procedures such as tarsorrhaphy to protect the eyes from the associated epithelial healing issues. Conjunctival flaps are considered in eyes with poor visual potential. The management of the acute condition is carried out in conjunction with measures to improve the tear volume bearing in mind the chances of delayed epithelialization and re-perforation in these cases. Administration of topical and systemic immunosuppression, when indicated, helps improve the outcome. This review aims to facilitate clinicians in instituting a synchronized multifaceted therapy for the successful management of corneal perforations in the setting of DED.

Dry eye disease (DED) is an emerging global health concern with meibomian gland dysfunction (MGD) being the most common subtype of DED. Despite being quite prevalent, the pathophysiological mechanisms governing MGD are poorly understood. Animal models for MGD can be a valuable resource to advance our understanding of this entity and explore novel diagnostic and therapeutic modalities. Although a lot of literature on rodent MGD models exists, a comprehensive review on rabbit animal models is lacking. Rabbits offer a great advantage over other animals as models for studying both DED and MGD. Rabbits have a widely exposed ocular surface and meibomian gland anatomy comparable with humans, which makes performing dry eye diagnostic tests possible using clinically validated imaging platforms. The existing MGD models in rabbits can broadly be classified as pharmacologically induced and surgically induced models. Most models show keratinization of the meibomian gland orifice with plugging as the final common pathway for developing MGD. Thus, understanding the advantages and disadvantages of each rabbit MGD model can help researchers choose the appropriate experimental plan based on the objective of the study. In this review, we discuss the comparative anatomy of the meibomian glands in humans and rabbits, various rabbit models of MGD, translational applications, unmet needs, and future directions in developing MGD models in rabbits.