OBJECTIVE: To study the efficacy and side-effect profile of topical 5-Fluorouracil (5-FU) in the treatment of ocular surface squamous neoplasia (OSSN).
METHODS: Retrospective study of 101 eyes of 100 patients treated with 5-FU with one week on and 3 weeks off regimen.
RESULTS: Of the 100 patients (101 eyes), the mean age at diagnosis of OSSN was 49 (median, 52 years; range, 11-87 years). History of prior intervention was noted in 6 (6%) eyes. Tumor epicenter included bulbar conjunctiva (n = 54; 53%), limbus (n = 27; 27%), and cornea (n = 20;20%). Mean number of cycles of topical 5-FU administered was 3 (median, 3; range, 1-8). Complete tumor regression was achieved with topical 5-FU in 89 (88%) eyes with a mean number of 2 cycles (median, 2; range, 1-6) of 5-FU. The remaining 12 (12%) lesions underwent additional treatment including excisional biopsy (n = 7), extended enucleation (n = 3), and topical Interferon alpha 2b (n = 2) for complete tumor control. Over a mean follow-up period of 6 months (median, 5 months; range, 1-36 months) following treatment, tumor recurrence was noted in 2 (2%) patients, and side-effects were noted in 7 (7%) eyes including conjunctival hyperemia (n = 1), punctal stenosis (n = 1), sterile keratitis (n = 4), and limbal stem cell deficiency (n = 1).
CONCLUSIONS: Topical 5-FU is an effective non-invasive therapy for OSSN with a minimal side-effect profile.

Allergic conjunctivitis (AC) is the most common form of allergic eye disease and an increasingly prevalent condition. Topical eye drop treatments are the usual approach for managing AC, although their impact on the ocular surface is not frequently investigated. The aim of this study was to perform a comparative physicochemical characterization, and in vitro biological evaluations in primary conjunctival and corneal epithelial cells of the new multidose preservative-free bilastine 0.6% and main commercially available eye drops. MTT assay was used to measure cell viability; oxidative stress was analyzed with a ROS-sensitive probe; and apoptosis was evaluated monitoring caspase 3/7 activation. Differences in pH value, osmolarity, viscosity and phosphate levels were identified. Among all formulations, bilastine exhibited pH, osmolarity and viscosity values closer to tear film (7.4, 300 mOsm/l and ~ 1.5-10 mPa·s, respectively), and was the only phosphates-free solution. Single-dose ketotifen did not induce ROS production, and single-dose azelastine and bilastine only induced a mild increase. Bilastine and single-dose ketotifen and azelastine showed high survival rates attributable to the absence of preservative in its formulation, not inducing caspase-3/7-mediated apoptosis after 24 h. Our findings support the use of the new bilastine 0.6% for treating patients with AC to preserve and maintain the integrity of the ocular surface.

OBJECTIVE: To evaluate the prevalence of oral bacteria in the conjunctiva of brachycephalic and nonbrachycephalic dogs.
METHODS: 12 brachycephalic (9.58 ± 3.55 years) and 12 nonbrachycephalic (8.33 ± 4.92 years) dogs without systemic disease, regardless of breed and sex, were included in the study, and half of the dogs in each group had periodontitis.
METHODS: This prospective study investigated clinical data including craniofacial ratio, ophthalmic examination results, and periodontal status of the included dogs. Bacterial samples were collected by swabbing the oral mucosa and conjunctival surfaces. The presence and quantity of bacteria were analyzed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, 16S rRNA sequencing analysis, and the 10-fold dilution method. Statistical analyses were performed to assess correlations and factors influencing the presence of oral bacteria in the conjunctiva.
RESULTS: The most common bacteria in the conjunctival flora in both groups were Micrococcus luteus, Corynebacterium spp, and Staphylococcus spp. The prevalence of oral bacteria on the conjunctival surface was 33%, with a significantly higher incidence in brachycephalic dogs (P = .027). Oral bacteria detected in the conjunctiva were predominantly Frederiksenia canicola, Neisseria spp, and Moraxella spp. Multiple regression analysis identified age, craniofacial ratio, and gingival index as factors influencing the presence of oral bacteria in the conjunctival flora.
CONCLUSIONS: Oral resident bacteria have often been isolated from severe infectious corneal ulcers. This study provided evidence that brachycephalic dogs may require dental prophylaxis to reduce their oral bacterial load and that the association of oral bacteria in ocular diseases should be considered.

OBJECTIVE: To investigate the relationship between prolonged face mask use and ocular surface health utilizing conjunctival impression cytology, the Schirmer test, the tear break-up time (TBUT) test, and the ocular surface disease index (OSDI) questionnaire.
METHODS: In this cross-sectional prospective study, individuals who used face masks for at least eight hours per day for at least six months were compared to healthy volunteers who used face masks for no more than one hour per day. Each participant completed an OSDI questionnaire. The Schirmer test (under anesthesia), the TBUT test, and conjunctiva impression cytology analysis according to the Nelson classification method were performed on each participant.
RESULTS: This study included 102 (49 male, 53 female) face mask users with an average age of 33.29 ± 7.71 years and 110 (60 male, 50 female) healthy controls with an average age of 32.96 ± 7.10 years (p = 0.746). The total OSDI score was significantly higher in face mask users than the control group (25.18 ± 3.54 vs 9.46 ± 2.13, p < 0.001). The mean Schirmer test value and TBUT were significantly lower in the study group than the control group (p < 0.001, p < 0.001). There was a statistically significant difference between the two groups in total score and stage of the Nelson classification system (p < 0.001, and p = 0.024, respectively). All conjunctiva impression cytology assessments, including cellularity, cell-cell contact, nucleus/cytoplasma ratio, goblet cell amount, and metaplasia, revealed statistically significant deterioration in the study group compared to the control group (p < 0.001, p = 0.025, p < 0.001, p < 0.001, and p < 0.001, respectively).
CONCLUSIONS: The prolonged use of face masks leads to dry eyes. The findings of conjunctiva impression cytology indicate the role of inflammation in the pathogenesis of mask associated dry eye.

OBJECTIVE: To compare the effect of povidone-iodine (PI) 5% and moxifloxacin 0.5% solutions versus PI 5% solution alone on the conjunctival bacterial flora.
METHODS: This is a comparative study in which the study population comprised adult patients scheduled for elective small incision cataract surgery. The eye to be operated (control eye) received topical moxifloxacin 0.5% drops 4 times, 1 day before surgery and 2 applications on the day of surgery. As placebo, the contralateral eye (study eye) received saline 0.90% drops as per the same schedule. Before surgery, on table, PI 5% was instilled in the conjunctival sac in both eyes. Conjunctival swabs were taken before initiation of therapy and 3 min after instillation of PI.
RESULTS: Of the 96 pairs of eyes included in the study, conjunctival cultures before prophylaxis were similar between the two groups (p = 0.31), with 54 samples (56%) of the study group and 49 (51%) of the control group showing growth. With positive cultures reducing to 7 (14%) in the study group and 8 (16%) in the control group, both the prophylaxis methods appeared equally efficacious (p = 0.79). Both the groups showed a significant reduction in positive cultures following prophylaxis (p < 0.0001).
CONCLUSIONS: PI 5% alone as preoperative prophylaxis was as effective as its combination therapy with moxifloxacin 0.5% in the reduction in conjunctival bacterial colonization.

OBJECTIVE: The purpose of this study was to report a series of patients with postoperative hemorrhage after Muller\'s muscle conjunctival resection surgery and compare risk factors and outcomes with a control population.
METHODS: In this case-control study, records of patients who underwent Muller\'s muscle conjunctival resection over 5 years were reviewed for a history of postoperative hemorrhage occurring >24 hours after surgery. A 4:1 control population was matched for age and sex. Clinical data collected included demographics, medical history, medications, and subsequent surgery. Preoperative and 3-month postoperative marginal reflex distance 1 were measured digitally using ImageJ. The hemorrhage and control groups were compared using Fisher\'s exact tests for categorical variables and independent samples t tests for continuous variables.
RESULTS: The hemorrhage group contained 10 patients (mean age 66.4 ± 18.5 years). The control group consisted of 40 age and sex-matched controls. Of 350 charts reviewed, there were 10 cases of postoperative hemorrhage (incidence 2.9%). Hemorrhage occurred a mean of 4.2 ± 1.3 (range 2-7) days after surgery and lasted for a mean of 29.3 ± 19.1 (range 12-72) hours. In all 10 cases, the bleeding resolved with conservative measures. There was no difference between the hemorrhage and control groups in terms of medical conditions, blood thinners, and surgical revision. Preoperative, postoperative, and change in marginal reflex distance 1 did not differ between the hemorrhage and control groups.
CONCLUSIONS: Hemorrhage occurs approximately 4-5 days postoperatively in a small percentage of patients undergoing Muller\'s muscle conjunctival resection surgery. This investigation did not identify any consistent risk factors, and outcomes in this patient population appear no different than controls.

UNASSIGNED: To determine if there is a difference in the quantity of microbial flora of the conjunctiva in individuals practicing head submersion (\"dunk\") versus no head submersion (\"no-dunk\") during hot tub use.
UNASSIGNED: In this double-blind randomized clinical trial, healthy volunteers aged ≥ 18 years were recruited. Participants were randomized to head submersion versus no head submersion during a 15-minute hot tub soak. Study personnel, masked to the dunk or no-dunk group assignment, obtained conjunctival cultures before and immediately after hot tub use. De-identified specimens were submitted to the clinical microbiology laboratory for culture and analysis. The main outcome measure was the difference in the quantity of organisms cultured from the conjunctiva before and after hot tub exposure, as determined using a defined ordinal scale. A two-tailed Student\'s t-test was performed to compare the total microbial colony counts between the two arms. Simpson\'s diversity was used to measure the changes in organism diversity between the arms.
UNASSIGNED: Of 36 enrolled subjects, 19 were randomly assigned to the dunk and 17 were assigned to the no-dunk groups. Water samples obtained from all hot tubs were culture negative. Eleven of 19 eyes (58%) from the dunk group and eight of 17 eyes (47%) from the no-dunk group had negative conjunctival bacterial cultures before and after hot tub exposure. However, six of 19 eyes (32%) and four of 17 eyes (24%) of the dunk and no-dunk groups, respectively, were culture-positive after, but not before hot tub exposure. The quantity of organisms before and after hot tub exposure was not significantly different between the two arms (P = 0.12). However, the dunk group only showed a small increase in the quantity of organisms after as compared to before hot tub use (P = 0.03). None of the samples from subjects or hot tubs were culture-positive for Acanthamoeba.
UNASSIGNED: Head submersion in a public hot tubs during a 15-minute soak does not appear to change conjunctival flora, as determined by culture plate yield, this does not eliminate the association between hot tub use and devastating and painful corneal blindness. Therefore, our recommendation is to remove contact lenses prior to hot tub use, avoid head submersion in a hot tub, and urgently seek ophthalmological help if any eye pain and/or decrease in vision is experienced after hot tub use.

OBJECTIVE: Diabetic retinopathy is a serious complication of diabetes mellitus that may lead to vision loss. Retinal problems are more likely to occur as the illness advances. Micro- and macro-vascular angiopathy is both linked to diabetes mellitus. Examining the impact of diabetes on blood vessels is one approach to understanding the disease\'s outward symptoms. The purpose of this research is to evaluate the morphology and breadth of conjunctival vessels in people with type 2 diabetes mellitus and to establish a correlation between these alterations and clinical retinal changes.
METHODS: A case-control study was conducted in the Department of Ophthalmology, KIMS, Koppal, Karnataka. The study included diabetic patients who voluntarily participated and were assessed at the Ophthalmology Outpatient Department (OPD). The general and ophthalmic history was taken for both cases and control. The best corrected visual acuity was estimated. Each subject, including cases and controls, had a general and ophthalmic history recorded. The anterior segment was evaluated with a slit lamp. After completing the clinical examination, the subjects underwent a conjunctival vessel imaging study using the slit lamp. The imaging included the study of conjunctival vessel morphology using ImageNet.
RESULTS: Both the test and control groups are comparable in terms of age and gender. The severity of diabetic retinopathy was shown to correlate with the conjunctival width range. Mild diabetic retinopathy is characterized by a conjunctival width of 30-34 microns (mean: 34.9), moderate diabetic retinopathy by 35-39 microns (mean: 37.3), severe diabetic retinopathy by 40-44 microns (mean: 42.4), and proliferative diabetic retinopathy by 50-54 microns (mean: 45.6).
CONCLUSIONS: Diabetes mellitus patients have larger conjunctival arteries as the disease becomes more severe. Dilated and tortuous conjunctival arteries are visible indicators that correlate with worsening diabetic retinopathy. This could be used for screening to ensure timely referral.

The conjunctival epithelium covering the eye contains two main cell types: mucus-producing goblet cells and water-secreting keratinocytes, which present mucins on their apical surface. Here, we describe long-term expanding organoids and air-liquid interface representing mouse and human conjunctiva. A single-cell RNA expression atlas of primary and cultured human conjunctiva reveals that keratinocytes express multiple antimicrobial peptides and identifies conjunctival tuft cells. IL-4/-13 exposure increases goblet and tuft cell differentiation and drastically modifies the conjunctiva secretome. Human NGFR+ basal cells are identified as bipotent conjunctiva stem cells. Conjunctival cultures can be infected by herpes simplex virus 1 (HSV1), human adenovirus 8 (hAdV8), and SARS-CoV-2. HSV1 infection was reversed by acyclovir addition, whereas hAdV8 infection, which lacks an approved drug therapy, was inhibited by cidofovir. We document transcriptional programs induced by HSV1 and hAdV8. Finally, conjunctival organoids can be transplanted. Together, human conjunctiva organoid cultures enable the study of conjunctival (patho)-physiology.

OBJECTIVE: Air pollutants, such as Asian sand and particulate matter (PM) 2.5, have become a global concern for causing ocular inflammation and allergic symptoms. This study, as part of an international investigation, examined the effects of eyewashes for ocular damage caused by air pollution in Indonesia.
METHODS: This was a single-center, patient- and-evaluator-blinded, parallel two-arm, nonrandomized trial. In Jakarta, Indonesia, 30 eyes of 15 car commuters and 30 eyes of 15 motorcycle commuters were recruited from healthy volunteers. After commuting to work, both eyes were washed with a commercial eyewash. Before and after eyewashing, eight items of ocular surface symptoms and four items of rhinitis subjective symptoms were scored using a modified Japanese Allergic Conjunctival Disease Quality-of-Life Questionnaire.
RESULTS: Five of the 12 subjective symptom scores before eyewashing were higher in motorcycle commuters than in car commuters (p < 0.05). Motorcycle commuters showed improvement in the five symptom scores of \"itchy eyes, foreign body sensation, eye mucus, dryness, and eye strain\" after eyewashing compared to before eyewashing (p < 0.05). In all patients, sootlike particles and ocular mucus were found in the solutions collected after eyewashing.
CONCLUSIONS: These findings indicate that eyewashing for ocular symptoms caused by airborne particles may be effective in removing foreign particles from the ocular surface and relieving subjective symptoms.