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Purpose of the current study was to introduce a new detailed aesthetical subunit (ASU) involvement chart to localize the defect configuration on the eyelids, and, to evaluate the aesthetical and functional outcomes of the post-oncological full-thickness eyelid defect reconstruction surgery by using a modified aesthetical rating guideline. Medical records of subjects who were diagnosed with a primary malignant full thickness eyelid tumor involving the eyelid margin and underwent full-thickness eyelid defect reconstruction surgery between April 2016 and May 2022 were retrospectively reviewed. Age, sex, pathological diagnosis, follow-up time, the ASU of the eyelid involvement, and surgical methods used to reconstruct the anterior and posterior lamella were examined from medical records. The reconstructed eyelid photos were scored according to the modified aesthetical rating guideline to analyze the aesthetical and functional outcomes of the surgeries. A total of 31 subjects were included to the study, and the overall mean aesthetical score was 3.5. Seventeen subjects with aesthetical scores greater than 3.5 were included in the more aesthetically pleasing (AP) group, and 14 subjects with aesthetical score less than 3.5 were included in less AP group. Anterior lamella repair was mainly performed using myo-cutaneous flaps in the more AP group and multiple flap combinations in the less AP group (P: 0.13). Posterior lamella reconstruction was performed using tarso-conjunctival tissue in both groups. In more AP group, tissue scarring, lash line disruption, eyelid thickness, and retraction or ectropion scores were significantly higher when compared with less AP group (P:0.03, P:0.03, P:0.02, and P:0.01, respectively). Subjects with fair eyelash color were significantly more common in more AP group (P: 0.009). The ASU involvement chart and outcomes of the current study may aid novice surgeons to determine which method will provide the best result for an individual patient for full-thickness eyelid defect repair and may offer some insight into the different surgical techniques used for repairing similar wounds. [ABSTRACT FROM AUTHOR]

• Chalazia are localized cysts of chronic lipogranulomatous inflammation. • The authors trace the chalazion's history from Ancient Babylon to the modern era. • Neoplasms must be considered for recurrent chalazia with atypical features. • This article summaries our current understanding of the chalazion. Chalazia are localized cysts of chronic lipogranulomatous inflammation arising from the obstruction of sebaceous glands of the eyelid tarsal plate, including the Meibomian gland (deep chalazion) or Zeis gland (superficial chalazion). This disease entity is differentiated from the hordeolum (stye), an acute purulent localized swelling of the eyelid often associated with an eyelash follicle, Zeis gland, or Moll gland obstruction and infection. Ambiguously, the chalazion, hordeolum, and blepharitis are commonly categorized and described on a continuum in the literature. While it is one of the most common eyelid disorders across all age demographics, the chalazion remains largely understudied and pathophysiological, epidemiological, and therapeutic findings exist fragmented in the literature. We discuss current understandings of the chalazion and provide current best practice guidelines supported by clinical anecdotal evidence. [ABSTRACT FROM AUTHOR]

This study presents dedicated hardware for iris localization that can be used as a coprocessor in the development of real-time and low-cost embedded iris biometric systems. Though the hardware architecture is described for iris localization in the visible wavelength (VW) images, the concept used can be applied to near infrared (NIR) images as well. In general, the architecture can be used for a class of iris localization algorithms based on the edge-map generation and circular Hough transform (CHT). The architecture presented here generates the edge-maps for limbic and pupil boundary detection using median filtering followed by Sobel edge detection; however, an additional reflection removal module is used for pupil boundary detection. Further, the CHT hardware module detects circle in each edge-map. The proposed architecture was implemented in programmable logic of the Zynq-7000 SoC device from Xilinx. This hardware implementation gives an iris localization accuracy of 98.43% and average processing time of 5.148 ms for UBIRIS.v1 VW database images (200 × 150 pixel). The algorithm used is suitable for less unconstrained and frontal-view iris images captured with subjects' active participation; however, the images may contain non-ideal issues such as reflection and occlusion by eyelids and eyelashes. [ABSTRACT FROM AUTHOR]

Periocular region is the feature rich region around the eye which may include features like eyelids, eyelashes, eyebrows, tear duct, eye shape, skin texture and many more. Periocular region based authentication system is a good trade-off between face and iris based biometric authentication systems as they need high user cooperation. This paper provides a comprehensive survey of periocular biometrics and a deep insight of various aspects such as utility of periocular region as a stand-alone modality, periocular region and its fusion with iris, application of periocular region in smart phone authentication and the role of periocular region in soft biometric classification etc. The paper also provides an outlook over possible future research in the area of periocular biometrics. [ABSTRACT FROM AUTHOR]

Pupil and iris segmentation based on ellipsis or circle recognition are sensitive to light reflections and reflected images. The method presented here is independent of size and shape and at the same time insensitive to light reflections and reflected mirror images. The pupil detected using the algorithm can be a reference point to further segmentation of the sclera of the eye as well as of the iris. The method is also effective when the pupil and iris are not positioned perpendicularly to the camera eye. The algorithm's average segmentation accuracy for all tested databases was 96% when considering only noisy and distorted images whilst a result of 100% was achieved with unblurred and clear images. The proposed method can be quickly and simply reproduced with a combination of known image processing methods. The developed algorithm for detecting the eyelid boundaries is effective with noisy and poor quality images due to the use of edge approximation using the Harmony Search Algorithm. An optimized shape detection method was used to detect the pupil and its edges. A method based on the variation and the average was used to eliminate shadows and eyelashes. The proposed scheme was tested on the UBIRIS.v1 database, MMU.v1 database and MILES databases, providing high results and short segmentation time. Segmentation accuracy for UBIRIS.v1 was 98.14%, for MMU.v1 – 90% and for MILES – 99.8%. [ABSTRACT FROM AUTHOR]

A key element of contact lens practice involves clinical evaluation of anterior eye health, including the cornea and limbus, conjunctiva and sclera, eyelids and eyelashes, lacrimal system and tear film. This report reviews the fundamental anatomy and physiology of these structures, including the vascular supply, venous drainage, lymphatic drainage, sensory innervation, physiology and function. This is the foundation for considering the potential interactions with, and effects of, contact lens wear on the anterior eye. This information is not consistently published as academic research and this report provides a synthesis from all available sources. With respect to terminology, the report aims to promote the consistent use of nomenclature in the field, and generally adopts anatomical terms recommended by the Federative Committee for Anatomical Terminology. Techniques for the examination of the ocular surface are also discussed. [ABSTRACT FROM AUTHOR]

To review the literature on the efficacy of intense pulsed light (IPL) on the eyelids in the management of meibomian gland disease (MGD) and meibomian gland–related ocular surface disease. A literature search was last conducted on May 15, 2019, in the PubMed and Cochrane Library databases for English-language original research that assessed the effect of IPL on MGD in adult patients. Thirty-three articles were identified, and 12 studies were determined to be relevant to the criteria outlined for assessment. The panel methodologist (V.K.A.) assigned a level of evidence rating to each study; 4 studies were rated level II, and 8 studies were rated level III. Five studies had potential conflicts of interest and design limitations that affected interpretation of results. All studies documented improvement in clinically meaningful metrics, including tear breakup time (TBUT), corneal staining and eyelid margin measurements, meibum quality, meibomian gland expressability, ocular surface disease index (OSDI), and standard patient evaluation of eye dryness (SPEED) questionnaire scores. Side effects were relatively uncommon but included discomfort, cutaneous erythema, blistering, eyelash loss, and floaters; these were uniformly self-limited. Although methodological limitations and potential conflicts of interest in some studies raised concern, the existing body of literature demonstrates improvements in the signs and symptoms of MGD after IPL therapy. [ABSTRACT FROM AUTHOR]

Purpose: To compare existing and novel diagnostic techniques for confirming ocular Demodex infestation and to recommend the most reliable method for routine use by eye care practitioners, based on yield and clinical applicability.Methods: Fifteen participants with a prior Demodex blepharitis diagnosis or featuring typical cylindrical dandruff (CD) collarettes, and seven healthy controls were enrolled. Demodex presence was assessed using five techniques, applied consecutively, on a minimum of two different eyelashes on each eyelid of every participant, for each test, in situ: 1. using fine-point forceps and 25-40x biomicroscopy magnification, by eyelash rotation as proposed by Mastrota (ROT); 2. by removing cylindrical dandruff and exposing the eyelash insertion point at the lid margin (CDR); and 3. by laterally tensioning the eyelash (LET) following CDR. The typical appearance of cigar-shaped mite tails protruding from each assessed eyelash follicle was observed, and mite tails counted and averaged per participant for each assessment technique. 4. Lash epilation, and mite presence evaluated using bright-field microscopy at 10-40x magnification (EPI). 5. Finally, eyelash follicles were imaged using in vivo confocal microscopy (IVCM) and the images visually inspected for mite presence.Results: In the Demodex group, the highest numbers of mites/eyelash were identified by LET (3.8 ± 1.4), versus CDR (2.4 ± 1.6) and ROT (1.1 ± 1.2), alone (all p < 0.002). An average of 1.0 ± 0.8 mites/lash was identified by EPI. IVCM failed to offer unequivocal evidence of Demodex presence even in confimed cases.Conclusions: A novel technique for the clinical diagnosis and grading of Demodex in situ is described. By removing cylindrical dandruff and applying static, lateral tension to the eyelash without epilation, large numbers of mites are visible at the exposed eyelash follicle. The proposed method is convenient and clinically applicable, requiring only forceps and 25-40x biomicroscope magnification, and allowing rapid, efficient evaluation of large numbers of eyelashes. [ABSTRACT FROM AUTHOR]

The normal structure and function of the eyelids, eyelashes, conjunctival fornices, and lacrimal system are essential for the health of the ocular surface, and abnormalities of these structures accompany many cases of ocular surface disease. We describe the role of oculoplastic intervention in the context of ocular surface disease, focusing on blink disorders, lagophthalmos, entropion, lid scarring and keratinization, trichiasis, and punctal and lacrimal sac disease. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effect blepharitis lid cleansers have on the tear film and ocular surface, and to examine the prevalence of Demodex folliculorum in a young population.Methods: Forty-eight university students completed a randomised, controlled, investigator-masked, eight-week clinical trial. Three eyelid hygiene products were investigated: blepharitis eyelid cleanser (OCuSOFT® Lid Scrub® PLUS foam), diluted baby shampoo (10% Johnson's® No More Tears ®) and a tea-tree based face wash (dr.organic®). Cooled boiled water was used as a control. Subjects attended for four visits: baseline, two weeks, four weeks and eight weeks. At each visit, subjective symptoms, non-invasive tear break up time, ocular surface staining and Demodex folliculorum investigation were assessed to evaluate any positive or negative effect on the tear film and ocular surface. Osmolarity was also measured at baseline and week eight only.Results: The overall prevalence of Demodex folliculorum found at baseline was 15%. Subjective symptoms improved in all groups, including control. There was no significant difference in mean osmolarity between the groups or within each group after eight weeks. There was a significant increase in osmolarity inter-eye variability in the baby shampoo group (5.5 ± 5.4 vs 15.2 ± 9.5; p = 0.03). There was no significant change in non-invasive tear break up time or ocular surface staining demonstrated after eight weeks of eyelid hygiene.Conclusion: A low prevalence of Demodex folliculorum can be found in a young population. All blepharitis lid cleansers used demonstrated subjective improvement in symptoms, with no negative effects on tear break-up time or ocular surface staining. The blepharitis eyelid cleanser and tea-tree based face wash revealed no adverse effect on mean osmolarity or inter-eye variability. Similarly, baby shampoo did not cause a significant increase in mean osmolarity, however, a significant increase in inter-eye variability was found; suggesting a possible increase in ocular surface inflammation. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate facial Demodex densities in participants with varying severities of blepharitis secondary to Demodex folliculorum assessed by the highest number of cylindrical dandruff on one lid.Methods: This double masked cross-sectional study included 58 participants [19 control, 21 mild/moderate and 18 severe Demodex blepharitis] who underwent a standardized skin-surface biopsy and a lash epilation for each lid to obtain the forehead Demodex densities and the overall lash mite count, respectively. Also, facial photographs were taken to evaluate facial erythema and dermatological conditions. The Ocular Surface Disease Index [OSDI], non-invasive break-up time [NIBUT], tear meniscus height [TMH], bulbar conjunctival redness as well as additional questions on watery eyes, ocular itching and itching along the lids were assessed.Results: Both mild/moderate and severe Demodex blepharitis groups were over the cut-off value [≥ 5 mites/cm2] that confirms a facial demodicosis (mild/moderate: 5 ± 1; severe: 6 ± 1) while the control group was below it (2 ± 1). Thereby, group comparisons showed that an increased severity of Demodex blepharitis was associated with higher forehead mite densities (p = 0.002) and increased lash mite count (p < 0.001). The degree of facial erythema was also positively correlated with forehead mite densities (rs = 0.31, p = 0.02). When compared to the controls, the mild/moderate group had more watery eyes (X2 = 6.54, p = 0.02), a lower TMH (U = 100.5, p = 0.006) and the severe group had more itching along the lids (X2 = 4.94, p = 0.04). The other ocular signs and symptoms [NIBUT, bulbar conjunctival redness, OSDI] were not affected by the severity of Demodex blepharitis (p > 0.05).Conclusion: Palpebral and facial Demodex infestation can co-exist, as the presence of blepharitis secondary to Demodex is associated with increased facial mite densities. [ABSTRACT FROM AUTHOR]

Ocular demodicosis can cause debilitating ocular surface disease. As ivermectin is effective at reducing Demodex proliferation in rosacea, this study investigated the efficacy of topical ivermectin 1.0% cream in treating ocular demodicosis. This retrospective single-centre clinical practice chart analysis involved the off-label treatment of patients who had ocular demodicosis with topical ivermectin 1.0 % cream (Soolantra, Galderma Ltd, UK) applied nightly to the lid margins of both eyes for 3 months. Ocular surface health was assessed at baseline when the treatment was prescribed and followed up at 3 and 12 months after baseline. Slit lamp biomicroscopy was used to take digital images of the upper eyelid lashes. Manual image analysis with ImageJ was conducted by a masked assessor to quantify signs of ocular demodicosis including the number of lashes with collarettes, with visible Demodex tails and with follicle pouting. Data from a total of 75 patients with ocular demodicosis were analysed for this study (mean age 66.6 ± 13.9 years, 44 female). The numbers of lashes with collarettes (Median [Interquartile range]: 8 [4–13] at baseline to 0 [0–2] at the final visit, p < 0.001) and lashes with follicle pouting (3 [1–5] at baseline to 0 [0–1.8] at the final visit, p < 0.001) decreased with treatment. Any sign of lashes with visible tails was eliminated by the final visit (p < 0.007). Fluorescein staining severity score also improved, particularly from baseline (1 [0–2]) to the second visit (0 [0–1], p < 0.001). The findings of this study show evidence for the efficacy of a 3-month course of topical ivermectin 1.0% cream in treating ocular demodicosis as indicated by reduction in collarettes, follicle pouting and visible Demodex tails. More research is warranted to improve the diagnosis, management and monitoring of this condition which is often overlooked or misdiagnosed. [ABSTRACT FROM AUTHOR]

More than 75 million people worldwide suffer from ocular hypertension (OHT)-associated retinal and optic nerve degenerative diseases that cause visual impairment and can lead to blindness. In an effort to find novel pharmaceutical therapeutics to combat OHT with reduced side-effect potential, several emerging drug candidates have advanced to human proof-of-concept in recent years. One such compound is a nonprostaglandin (non-PG) EP2-receptor-selective agonist (omidenepag isopropyl ester). Omidenepag (OMD; free acid form) is a novel non-PG that selectively binds to and activates the human EP2-prostglandin receptor (EP2R) with a high affinity (K i = 3.6 nM) and which potently generates intracellular cAMP in living cells (EC 50 = 3.9–8.3 nM). OMD significantly downregulated COL12A1 and COL13A1 mRNAs in human trabecular meshwork (TM) cells, a tissue involved in the pathogenesis of OHT. Omidenepag isopropyl (OMDI) potently and efficaciously lowered intraocular pressure (IOP) in ocular normotensive rabbits, dogs, and monkeys, and also in ocular hypertension (OHT) Cynomolgus monkeys, after a single topical ocular (t.o.) instillation at doses of 0.0001–0.01%. No reduction in IOP-lowering response to OMDI was observed after repeated t.o. dosing with OMDI in dogs and monkeys. Additive IOP reduction to OMDI was noted with brinzolamide, timolol, and brimonidine in rabbits and monkeys. OMDI 0.002% t.o. decreased IOP by stimulating the conventional (TM) and uveoscleral (UVSC) outflow of aqueous humor (AQH) in OHT monkeys. In a Phase-III clinical investigation, 0.002% OMDI (once daily t.o.) reduced IOP by 5–6 mmHg in OHT/primary open-angle glaucoma (POAG) patients (22–34 mmHg baseline IOPs) that was maintained over 12-months. In an additional month-long clinical study, 0.002% OMDI induced IOP-lowering equivalent to that of latanoprost (0.005%), a prostanoid FP-receptor agonist, thus OMDI was noninferior to latanoprost. Additive IOPreduction was also noted in OHT/OAG patients when OMDI (0.002%, once daily t.o.) and timolol (0.05%, twice daily t.o.) were administered. Patients with OHT/POAG who were low responders or nonresponders to latanoprost (0.005%, q.d.; t.o.) experienced significant IOP-lowering (additional approximately 3 mmHg) when they were switched over to OMDI 0.002% (q.d.; t.o.). No systemic or ocular adverse reactions (e.g. iris color changes/deepening of the upper eyelid sulcus/abnormal eyelash growth) were noted after a year-long, once-daily t.o. dosing with 0.002 % OMDI in OHT/POAG patients. However, OMDI caused transient conjunctival hyperemia. These characteristics of OMDI render it a suitable new medication for treating OHT and various types of glaucoma, especially where elevated IOP is implicated. [ABSTRACT FROM AUTHOR]

Purpose: To compare the in vitro anti-demodectic activity of four commercially available dedicated eyelid cleansers (Cliradex® towelette cleanser, Oust™ Demodex® cleanser, Blephadex™ eyelid foam, TheraTears® SteriLid® eyelid cleanser), tea tree oil, undiluted terpinen-4-ol and linalool; and to assess the terpinen-4-ol content of the commercial cleansers and tea tree oil.Methods: In vitro anti-demodectic efficacy assessment: 93 viable Demodex mites were acquired from the epilated eyelashes of 10 participants, and were randomised to application with one of the four eyelid cleansers, 100% and 50% tea tree oil, undiluted terpinen-4-ol and linalool, or no treatment. Following treatment application, mite viability was assessed for 300 min, based on limb/body movement and/or the development of a crenated/translucent appearance. Kaplan-Meier survival analysis was then performed.Mass Spectrometry Analysis: The absolute concentration of terpinen-4-ol and the relative abundance of linalool in the four eyelid cleansers and tea tree oil were determined.Results: In vitro anti-demodectic efficacy assessment: No significant differences were observed between undiluted tea tree oil, terpinen-4-ol and linalool (all p > 0.05). Although all commercial eyelid cleansers effected lower mite survival probabilities than the untreated group, Cliradex® was the only eyelid cleanser that demonstrated comparable antiparastic activity to 50% tea tree oil (p = 0.36).Mass Spectrometry Analysis: Among the four eyelid cleansers, Cliradex® contained the highest concentration of terpinen-4-ol, while linalool was present in TheraTears® SteriLid® only.Conclusions: Of the four commercial eyelid cleansers, Cliradex® demonstrated the highest levels of in vitro anti-demodectic activity and terpinen-4-ol content. Undiluted linalool and terpenin-4-ol showed comparable antiparasitic efficacy, and the use of linalool in the management of demodectic blepharitis warrants further investigation. [ABSTRACT FROM AUTHOR]

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Although human eyelashes are generally curved, the cause of the natural curvature of eyelashes has not yet to be clarified elsewhere. Related with this, this paper reports our discovery of a correlation between the curvature of the eyelash and its geometrical features. Eyelashes can be divided into root, middle and tip sections. Because the curvature at the root is larger than that at the tip, we expected that the root section could be more easily deformed by bending compared with the tip section. However, the structural elasticity in bending, which is the flexural rigidity without depending on the external dimensions, at the root was found to be greater than that at the tip, contrary to our initial expectations. Next we examined the internal dimensions of cross sections of the eyelashes, and found that the thicknesses of the cuticle layer at the root were different for the convex and concave sides of the curved eyelash, although these were almost the same at the tip. Theoretical analysis of this variation in thickness of the outer cuticle layer shows that this displaces the neutral axis. Finally, we found that there is a good correlation between the displacement of the neutral axis and the curvature of the eyelash. Statement of Significance Why are human eyelashes naturally curved? To find a hint for this question, the mechanical and geometrical properties of human eyelash were investigated. Although the curvature at the root of the eyelash was larger than that at the tip, this was not related to the deformability of the eyelash by bending. From the cross-sectional observation of eyelash, we noticed that the thickness of the outer cuticle layer was non-uniform depending on the position, and this brought the displacement of the neutral axis of the eyelash for bending. Finally, a good correlation between the curvature and the change in the neutral axis was discovered. With practically using this findings, the curvature of the eyelash might be controlled artificially in the future. [ABSTRACT FROM AUTHOR]

Over a 2-year period, swellings of all 4 eyelid margins developed in a 32-year-old woman and was accompanied by complete loss of eyelashes. An inflammatory dermatologic condition was considered the most likely cause. A full-thickness right lower eyelid biopsy revealed a multinodular lymphoid tumor at the eyelid margin which immunophenotypically and genetically was diagnosed as an extranodal marginal zone lymphoma. The mode of presentation of the disease was considered to be most unusual, as was its B cell lineage, since the majority of primary cutaneous lymphomas are of T-cell origin. Systemic workup demonstrated bilateral involvement of the external auditory canals. [ABSTRACT FROM AUTHOR]

Purpose: To compare the efficacy of Dr Organic Tea Tree Face Wash, OcuSoft Lids Scrub Plus and the BlephEx™ device at treating of Demodex folliculorum blepharitis.Methods: Eighty-six subjects (33 males/36 females) were enrolled in a randomised controlled interventional treatment study. Subjects completed a dry eye symptom questionnaire and were assessed for presence of Demodex folliculorum. Subjects were divided into three groups according to treatment: Dr Organic Tea Tree Face Wash (A) (n=28), OcuSoft Lid Scrub Plus (B) (n=30), or in-house lid scrub with the BlephEx™ device before nightly lid scrubs with OcuSoft Lid Scrub Plus (C) (n=28). Subjects were advised to clean their eyelids nightly for four weeks. Each subject was re-assessed for symptoms and Demodex folliculorum blepharitis after two weeks and four weeks of treatment.Results: The quantity of Demodex folliculorum was significantly reduced after four weeks of treatment in all three groups (p<0.05). Overall, there was no difference in efficacy between the three treatments (p>0.1). Symptoms reported by subjects were significantly improved after two and four weeks of treatment (p<0.05). Overall, there was no difference in efficacy between the three treatments to reduce symptoms after two or four weeks (p= 0.813 and p=0.646 respectively).Conclusion: All three methods tested have shown good ability to reduce Demodex folliculorum quantity, improve subjective symptoms and help treat Demodex folliculorum blepharitis. [ABSTRACT FROM AUTHOR]

Numerous reports point to Demodex mites as the aetiology of certain eye and skin conditions, hence it is highly probable that infestation with these mites may also play a role in the aetiology and pathogenesis of pterygium. Therefore here we present a hypothesis: whether the presence of Demodex mites in eyelash hair follicles significantly correlates with the presence of pterygia, which could point to a potential role of these mites in the development of such lesions. We present preliminary data for supporting this hypothesis. These results were collected from a group of 69 subjects, including 39 with pterygium. Subjects were studied for the presence of Demodex folliculorum and/or D. brevis within eyelash follicles. The sample was defined as positive if at least one parasite, larva or egg were present. Preliminary statistical analyses were performed, and indicated a significant relationship between Demodex mite infestation and the presence of pterygium (p<0.05). This suggests that demodicosis could be one of the factors causing pterygium and significantly contribute to its development. Subjects who had both pterygium and Demodex infestation formed a dominant group. The proportion of subjects with both pterygia and Demodex presence is high at 93.33%, while the proportion of subjects without pterygia who have mites is low at 20.51%. Aforementioned results support our working hypothesis that infestation with Demodex mites may result in pterygium development and therefore patients diagnosed with pterygium should be assessed for the presence of Demodex to verify our preliminary results. In the present paper, we discuss potential influence of Demodex on conjunctiva and propose a hypothetical pathological mechanism linking the development of pterygia with demodicosis. [ABSTRACT FROM AUTHOR]

• Iris recognition is a prominent biometric system because of it is easy to use, high accuracy, fast identification time, accurate matching performance and difficult to spoof. • the iris recognition's accuracy can be affected because of reflection, motion blur and deformation of pupillary boundary. • Iris recognition may suffer if pupillary boundary is not correctly segmented. • Moreover, pupillary boundary can deform into uneven shape instead of circular shape. • After that, reflection in pupil area is eliminated with morphological closing. • The accurate pupillary boundary can be segmented after reflection elimination. Iris recognition is a robust biometric system—user-friendly, accurate, fast, and reliable. This biometric system captures information in a contactless manner, making it suitable for use during the COVID-19 pandemic. Despite its advantages such as high security and high accuracy, iris recognition still suffers from pupil deformation, motion blur, eyelids blocking, reflection occlusion and eyelashes obscure. If the pupillary boundary is not accurately segmented, iris recognition may suffer tremendously. Moreover, reflections in iris image may lead to an incorrect pupillary boundary segmentation. The segmentation accuracy can also be affected and reduced because of the presence of an unwanted noise created by the motion blur effect in iris image. Additionally, the pupillary boundary might change from circular shape to uneven or irregular shape because of the interference and obstruction in pupil region. Therefore, this work is carried out to determine an accurate, efficient and fast algorithm for the segmentation of pupillary boundary. First, the iris image is pre-processed with Wiener filter. Next, the respective iris image is assigned with a specific threshold. After that, the pixel property in iris image is computed to determine the pupillary boundary coordinates which are acquired from the measured pixel list and area in iris image. Finally, morphological closing is used to remove reflections in the inner region of pupil boundary. All experiments are implemented with CASIA v4 database and Matlab R2020a. [ABSTRACT FROM AUTHOR]

We Summarize a three cases of transient fetal hypertrichosis in low risk preganant women. Hypertrichosis has been previously associated with over 140 different syndromes (OMIM); however this finding is rarely described in prenatal ultrasound. In this study we describe the finding of hypertrichosis which resolved later in gestation. CASE N1: A prominent unibrow (synophrys) and elongated eyelashes were noted at 24 weeks of gestation with no other abnormal features. CASE N 2: A prenatal ultrasound scan was performed at 24 weeks and revealed: horseshoe kidney and localized hypertrichosis on the lower back. CASE N 3: Ultrasound exam at 24 weeks of gestation demonstrated localized hypertrichosis on the chin. CONCLUSION: Transient localized hypertrichosis with no other major findings has a favorable prenatal outcome. [ABSTRACT FROM AUTHOR]

In recent years, cosmetics deemed equivalent to pharmaceutical products containing prostaglandin F 2α (PGF 2α) analogs have been distributed overseas in the form of eyelash serums that can be purchased via the internet. The purpose of this study was to investigate the presence or absence of PGF 2α analogs in eyelash serums procured in Japan via the internet to elucidate the actual composition. A liquid chromatography-tandem mass spectrometry (LC-MS/MS) measurement system was developed for the determination of 14 PGF 2α analogs in cosmetic serums. In total, 64 eyelash serum samples were purchased from 34 websites. After pretreatment, eyelash serum samples were screened for PGF 2α analogs using the LC-MS/MS system. Products containing PGF 2α analogs were subjected to quantification of these compounds. Of the 64 products, four were found to contain bimatoprost, among which, three did not indicate their contents on their package labels. In contrast, no samples were found to contain latanoprost, travoprost, or tafluprost, which are prescribed for glaucoma treatment. Additionally, eight products contained other PGF 2α analogs, which have not been used as pharmaceuticals. The ease of access to cosmetic serums containing PGF 2α analogs via online purchases presents a risk of serious side effects, particularly when consumers are not informed of their contents on the packages. This issue requires serious consideration to avoid the incorporation of pharmaceutical substances into cosmetic products. • Eyelash serums containing undeclared prostaglandin F 2α (PGF 2α) analogs of pharmaceutical grade can be bought online. • Content of PGF 2α analogs were quantified in serum samples with newly developed LC-MS/MS. • Among 64 products, 12 contained PGF 2α analogs including bimatoprost in four samples. • A number of these serums do not list the presence of the analog on their package. • The ease of access to such sera containing PGF 2α analogs with known and unknown side effects may threaten consumers' safety. [ABSTRACT FROM AUTHOR]

Eyebrows, eyelashes, and eyelids are cosmetically and functionally important periocular landmarks that offer insights into a patient’s emotional state. Several pathologies exist with respect to the eyebrows, eyelashes, and eyelids. Madarosis refers to loss of the eyebrows or eyelashes; milphosis refers specifically to eyelash loss. Excess growth of eyelash hair is termed trichomegaly. Excess skin in the upper or lower eyelids is called dermatochalasis. Pathology of these important structures can be reflective of important local and systemic disease processes. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety and efficacy of lotilaner ophthalmic solution, 0.25% for the treatment of blepharitis due to Demodex infestation compared to vehicle control.Methods: In this phase II, randomized, controlled, double-masked clinical trial, 60 eligible participants with Demodex blepharitis were randomly assigned in a 1:1 ratio to receive either topical lotilaner ophthalmic solution, 0.25% (Tarsus Pharmaceuticals, Inc., Irvine, CA) (study group) or the vehicle without lotilaner (control group) bilaterally twice a day for 28 days. Participants were followed at Days 7, 14, 28, 60 and 90. The efficacy parameters were change in collarette grade and Demodex density at Day 28. Safety parameters were adverse events, changes in corrected distance visual acuity (CDVA), intraocular pressure (IOP) and slit-lamp biomicroscopy.Results: The study group showed a statistically significant decrease in collarette grade compared to the control group beginning at Day 14 (p = 0.003) in the upper eyelid and at Day 28 (p = 0.003) in the lower eyelid. Decreases in both lids were maintained through Day 90 (p < 0.001). At Day 28, mite eradication was achieved in 66.7% and 25.9% of eyes in the study and control group (p = 0.005); at Day 90, these proportions were 68.2% and 18.5% (p = 0.001), respectively. No serious adverse events or clinically significant changes in CDVA and IOP were observed.Conclusion: For Demodex blepharitis, treatment with lotilaner ophthalmic solution, 0.25% for 4 weeks is safe and effective. The improvement in collarette grade and mite density observed during the treatment period persisted for at least two months following treatment cessation. [ABSTRACT FROM AUTHOR]

Clin Microbiol Infect 2012; 18: 1020-1025 Abstract To better recognize the pathogenicity of ocular Demodex mites, we analysed Bacillus oleronius infection in patients with Demodex-related chronic blepharitis. The studies were conducted on 68 adult patients, in whom ophthalmological and parasitological tests permitted the distinction of a group of 38 patients with a diagnosis of Demodex-related chronic blepharitis (group 1, including a subgroup 1a with moderate blepharitis and a subgroup 1b with severe blepharitis) and a group of 30 healthy individuals (group 2). In every person studied six eyelashes were epilated from each eye and the number of Demodex per eyelash was scored. In parallel, bacterial culture and isolation allowed their phenotypic and molecular identification. The drug sensitivity of the isolates was tested using E-tests. Intensity of Demodex infestation showed no significant differences between subgroups 1a and 1b. From the epilated eyelashes 23 bacterial isolates were obtained, identified as being B. oleronius. All the studied strains were sensitive to ciprofloxacin, doxycycline and gentamicin. The Demodex mite represents an independent aetiopathogenetic factor in blepharitis. In parallel, the parasite may act as a carrier of B. oleronius bacteria, which most probably function as a co-pathogen in the development of severe forms of blepharitis. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Ophthalmology is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: One of the most challenging issues in iris recognition is the design of techniques able to ensure high accuracy even in adverse conditions. This paper deals with an approach to iris matching based on the combination of local features: Linear Binary Patterns (LBP) and discriminable textons (BLOBs) are presently exploited. The techniques have been refined ad hoc, to allow the extraction of significant discriminative features, even with images captured in variable visible light conditions, and affected by noise due to distance/resolution or to scarce user collaboration (blurring, off-axis iris, occlusion by eyelashes and eyelids). The obtained results strongly motivate further investigations along this line, most of all the addition of more local features. [Copyright &y& Elsevier]

Abstract: Trichiasis is the sight-threatening consequence of conjunctival scarring in trachoma, the most common infectious cause of blindness worldwide. Trachomatous trichiasis is the result of multiple infections from childhood with Chlamydia trachomatis, which causes recurrent chronic inflammation in the tarsal conjunctiva. This produces conjunctival scarring, entropion, trichiasis, and ultimately blinding corneal opacification. The disease causes painful, usually irreversible sight loss. Over eight million people have trachomatous trichiasis, mostly those living in poor rural communities in 57 endemic countries. The global cost is estimated at US$ 5.3 billion. The WHO recommends surgery as part of the SAFE strategy for controlling the disease.We examine the principles of clinical management, treatment options, and the challenging issues of providing the quantity and quality of surgery that is needed in resource-poor settings. [Copyright &y& Elsevier]

Abstract: As one of the most effective ways in biometrics, Iris Identification has drawn more and more attention in recognition technology. Fruitful achievement, both theoretically and practically, have been made and widely applied to various fields and industries. However, iris identification is easily affected by noises such as eyelashes, eyelids, sampling flares, and its quality and speed in actual practice is not so effective. We analyses the general approach based on the extraction and matching of feature code, and then design an new iris identification algorithm based on multi-scale gray matching. It proposes a standardized solution for the noise integration of using in login and sample iris images, and uses directly surface match way to judge recognition.With the method, we can extract more junior primitive iris data, analyses and process them, and increase area used to iris identification, reduce residual caused by the no unified available area. The results show that the algorithm has virtues of both accuracy and speed, and has some applicated fields. [Copyright &y& Elsevier]

Abstract: The iris identification as one of the most effective ways in biometrics identification, which obtain more and more attention in all walks of life to a wide range of applications, but the recognition of the quality and speed still exist noise interference such as eyelash, eyelid, and sampling flare. In the paper we put forward a method that unified noise used to between login iris and sample iris images aiming at the widespread adoption of matching method. Basing on this way, we can effectively reduce the noise interference and increase for identification of utilization as soon as possible. It is found that the method can be applied to reduce regional differences resulted from noise regional disunity errors, and make us to get more effective iris image area, especially in inferiorly non-aggressive iris image area. Our study Indicates the result of calculation iris matching has better effect in direct gray-level surface. [Copyright &y& Elsevier]

Abstract: The objective of this work is to evaluate topographical variation in the ocular surface temperature (OST) among the young, elderly and the subjects wearing contact lens using thermographic methodology. We recorded thermographic sequence lasting of 25s for each eye. The ocular region in each of the thermal images in the sequence was identified and warped into a standard form. Then, the warped sequence was divided into a number of sub-sequences. A differential image which is an image matrix was obtained from each of these sub-sequences, by subtracting thermal images within the sub-sequence. And the histogram of the differential image was modelled by Gaussian mixture model to discriminate eyelashes from the ocular surface for every thermal image in the sub-sequence. Later, thermal data of eyelashes were eliminated in every thermal image and statistical analysis was performed on the sequences. Finally, topographical profile of each subject group was approximated by equations and illustrated using various temperature profiles. The ocular surface of the young subject was observed to be the warmest, and tear film was determined to play a major role in the topographical and temporal variations in OST. Significant topographical variation was observed among subject groups. Based on our compiled average OST profile (AOSTP), the maximum predictability of the bioheat simulation on ocular model can reach up to 90%. [Copyright &y& Elsevier]

Abstract: The periocular region is the part of the face immediately surrounding the eye, and researchers have recently begun to investigate how to use the periocular region for recognition. Understanding how humans recognize faces helped computer vision researchers develop algorithms for face recognition. Likewise, understanding how humans analyze periocular images could benefit researchers developing algorithms for periocular recognition. We conducted two experiments to determine how humans analyze periocular images. In these experiments, we presented pairs of images and asked volunteers to determine whether the two images showed eyes from the same subject or from different subjects. In the first experiment, subjects were paired randomly to create different-subject queries. Our volunteers correctly determined the relationship between the two images in 92% of the queries. In the second experiment, we considered multiple factors in forming different-subject pairs; queries were formed from pairs of subjects with the same gender and race, and with similar eye color, makeup, eyelash length, and eye occlusion. In addition, we limited the amount of time volunteers could view a query pair. On this harder experiment, the correct verification rate was 79%. We asked volunteers to describe what features in the images were helpful to them in making their decisions. In both experiments, eyelashes were reported to be the most helpful feature. [Copyright &y& Elsevier]

Abstract: Diseases of the periocular hair range from localized disease to systemic processes and may present challenging diagnostic questions. We present a comprehensive clinical guide to the evaluation and diagnosis of these disorders. Deficiencies in growth, excess production, changes in pigmentation, aberrant position, or abnormalities in form may affect this region’s hair. These range from benign to sight-, and even life-, threatening pathologies. [Copyright &y& Elsevier]

Summary: Upper-eyelid trichiasis often occurs with a single puffy eyelid or shallow eyelid crease in young Asian patients. This study presents a novel modified trichiasis correction method to simultaneously treat trichiasis and create a natural eyelid crease. It combines the modified small-incision debulking procedure and the orbicularis–levator fixation technique. The eyelash lift angle (LA), body curl angle (BCA) and end curl angle (ECA) were quantitatively analysed. A total of 90 patients (152 trichiasis eyelids) were followed up for approximately 22 months. The LA changed from 24.32° ± 9.21°–54.12° ± 10.32° in the nasal section of the eyelid (section 1), from 21.03° ± 11.34°–52.03° ± 10.56° in the middle section of the eyelid (section 2) and from 23.31° ± 8.12°–63.15° ± 8.43° in the temporal section of the eyelid (section 3). All patients were satisfied with the eyelid-fold appearance. In conclusion, for young Asian patients with upper-eyelid trichiasis, the small-incision orbicularis-levator fixation technique is able to acquire a stable up-curved position of the eyelashes and satisfactory aesthetic results. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the physical functioning of Ethiopian trichiasis surgery patients before and 6 months after surgery. Design: Nested cohort study. Methods: This study was nested within the Surgery for Trichiasis, Antibiotics to Prevent Recurrence (STAR) clinical trial conducted in Ethiopia. Demographic information, ocular examinations, and physical functioning assessments were collected before and 6 months after surgery. A single score for patients'' physical functioning was constructed using Rasch analysis. A multivariate linear regression model was used to determine if change in physical functioning was associated with change in visual acuity. Results: Of the 438 participants, 411 (93.8%) had both baseline and follow-up questionnaires. Physical functioning scores at baseline ranged from −6.32 (great difficulty) to +6.01 (no difficulty). The percentage of participants reporting no difficulty in physical functioning increased by 32.6%; the proportion of participants in the mild/no visual impairment category increased by 8.6%. A multivariate linear regression model showed that for every line of vision gained, physical functioning improves significantly (0.09 units; 95% CI: 0.02–0.16). Conclusions: Surgery to correct trichiasis appears to improve patients'' physical functioning as measured at 6 months. More effort in promoting trichiasis surgery is essential, not only to prevent corneal blindness, but also to enable improved functioning in daily life. [Copyright &y& Elsevier]

Abstract: Continuous efforts have been made to process degraded iris images for enhancement of the iris recognition performance in unconstrained situations. Recently, many researchers have focused on developing the iris segmentation techniques, which can deal with iris images in a non-cooperative environment where the probability of acquiring unideal iris images is very high due to gaze deviation, noise, blurring, and occlusion by eyelashes, eyelids, glasses, and hair. Although there have been many iris segmentation methods, most focus primarily on the accurate detection of iris images captured in a closely controlled environment. The novelty of this research effort is that we propose to apply a variational level set-based curve evolution scheme that uses a significantly larger time step to numerically solve the evolution partial differential equation (PDE) for segmentation of an unideal iris image accurately, and thereby, speeding up the curve evolution process drastically. The iris boundary represented by the variational level set may break and merge naturally during evolution, and thus, the topological changes are handled automatically. The proposed variational model is also robust against poor localization and weak iris/sclera boundaries. In order to solve the size irregularities occurring due to arbitrary shapes of the extracted iris/pupil regions, a simple method is applied based on connection of adjacent contour points. Furthermore, to reduce the noise effect, we apply a pixel-wise adaptive 2D Wiener filter. The verification and identification performance of the proposed scheme is validated on three challenging iris image datasets, namely, the ICE 2005, the WVU Unideal, and the UBIRIS Version 1. [Copyright &y& Elsevier]

Objective: To determine whether bimatoprost (Lumigan, Allergan Inc., Irvine, CA) causes increased lash length when used in gel suspension applied to the base of the eyelashes. Design: Randomized controlled trial. Participants: Nineteen subjects were enrolled. Methods: Subjects recruited from the Bascom Palmer Eye Institute were screened, and those who met inclusion criteria were enrolled. Each participant received 2 vials of gel suspension, which contained bimatoprost and normal saline, respectively, each mixed 1:1 with Gonak gel (Akorn Inc., Lake Forest, IL) and labeled “right eye” and “left eye” according to randomization. The suspension was applied to the upper eyelid eyelashes every evening on the designated eye for 6 weeks. Main Outcome Measures: Lash length was measured with a caliper at enrollment, at weekly intervals during the application of the gel, and at 1 and 3 months after discontinuation of its use. Visual acuity, ocular symptoms, intraocular pressure, and photographs were documented at these same intervals. Results: The mean eyelash growth from baseline in the bimatoprost group was 2.0 mm versus a mean of 1.1 mm in the placebo group, which was a statistically significant difference (P=0.009). The average intraocular pressure decreased equally in both groups (2 mmHg). No change in visual acuity or iris discoloration was noted in any of the subjects. Conclusions: Our data showed an increase in eyelash length with the use of bimatoprost in gel suspension, suggesting the product''s eyelash-lengthening properties. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

Abstract: Many researchers have studied iris recognition techniques in unconstrained environments, where the probability of acquiring non-ideal iris images is very high due to off-angles, noise, blurring and occlusion by eyelashes, eyelids, glasses, and hair. Although there have been many iris segmentation methods, most focus primarily on the accurate detection with iris images which are captured in a closely controlled environment. This paper proposes a new iris segmentation method that can be used to accurately extract iris regions from non-ideal quality iris images. This research has following three novelties compared to previous works; firstly, the proposed method uses AdaBoost eye detection in order to compensate for the iris detection error caused by the two circular edge detection operations; secondly, it uses a color segmentation technique for detecting obstructions by the ghosting effects of visible light; and thirdly, if there is no extracted corneal specular reflection in the detected pupil and iris regions, the captured iris image is determined as a “closed eye” image. The proposed method has been tested using the UBIRIS.v2 database via NICE.I (Noisy Iris Challenge Evaluation – Part I) contest. The results show that FP (False Positive) error rate and FN (False Negative) error rate are 1.2% and 27.6%, respectively, from NICE.I report (the 5th highest rank). [Copyright &y& Elsevier]

Abstract: The paper presents an innovative algorithm for the segmentation of the iris in noisy images, with boundaries regularization and the removal of the possible existing reflections. In particular, the method aims to extract the iris pattern from the eye image acquired at the visible wavelength, in an uncontrolled environment where reflections and occlusions can also be present, on-the-move and at variable distance. The method achieves the iris segmentation by the following three main steps. The first step locates the centers of the pupil and the iris in the input image. Then two image strips containing the iris boundaries are extracted and linearizated. The last step locates the iris boundary points in the strips and it performs a regularization operation by achieving the exclusion of the outliers and the interpolation of missing points. The obtained curves are then converted into the original image space in order to produce a first segmentation output. Occlusions such as reflections and eyelashes are then identified and removed from the final area of the segmentation. Results indicate that the presented approach is effective and suitable to deal with the iris acquisition in noisy environments. The proposed algorithm ranked seventh in the international Noisy Iris Challenge Evaluation (NICE.I). [Copyright &y& Elsevier]

Summary: Anatomically, the upper eyelids of an Asian are considerably unique, and nearly half of the East Asians have single eyelids. This study presents a new, modified, Asian-specialised procedure to simultaneously treat trichiasis and dermatochalasis. It combines anterior lamellar repositioning with lid split surgery and blepharoplasty, and creates a completely penetrating anterior lamellar flap so as to fully shift the anterior lid margin upwards. Between May 2004 and May 2006, 114 cases (144 eyelids) were operated and followed-up for at least 12 months. Lid margin and eyelash position, improvement of symptoms, recurrence rate, overcorrection and aesthetic appearance were assessed at each visit. Of the 144 eyelids operated, the recurrence rate was 0% at 3 months, 2.8% at 6 months and 5.6% at 12 months. There was no case of secondary lid ectropion or retraction, and the aesthetic alterations were accepted by all the patients. In conclusion, the modified operation – anterior lamellar repositioning with complete lid split – is an effective, personalised method for the treatment of upper eyelids trichiasis in Asian patients. [Copyright &y& Elsevier]

Abstract: Eyelids and eyelashes occluding the iris region are noise factors that degrade the performance of iris recognition. If they are incorrectly classified as an iris region, the false iris region information decreases the recognition rate. Thus, reliable detection of eyelids and eyelashes is required to improve the performance of iris recognition. In this paper, we propose an automatic eyelid and eyelash detection method based on the parabolic Hough model and Otsu’s thresholding method. By applying the parabolic Hough transform to the normalized iris image, rather than to the original image, we reduce the dimension of the parameter space and limit the parameter search range, decreasing the computational load. In addition, for automatically separating the eyelash region we apply Otsu’s method to the proposed feature that is obtained by combining the intensity and local standard deviation values. The proposed method is applied to the CASIA version 3 database and the performance of the proposed and six existing methods is assessed in terms of the decidability, equal error rate, and detection error trade-off curve. In terms of these performance measures, the proposed method shows the better performance than conventional methods. [Copyright &y& Elsevier]

Abstract: Precise pupil center detection is an important factor for gaze tracking in video-oculography (VOG) systems. Existing methods perform well to extract the features when the area of pupil in eye image is clear, whereas, interferences, such as eyelashes, corneal reflection etc., will lead to a low success rate. One main reason is the closure of eyelids. In this paper, a systemic 3D transformation algorithm is proposed to accurately ascertain the pupil center, in spite of the complicating factors mentioned above. Experiments show the good performance of our method. And the pupil center could be extracted accurately, even though only 25% of the pupil is visible. [Copyright &y& Elsevier]

Copyright of Canadian Journal of Ophthalmology is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: For accurate iris recognition, it is essential to detect eyelash regions and remove them for iris code generation, since eyelashes act as noise factors in the iris recognition. In addition, eyelash positions can be changed for enrollment and recognition and this may cause FR (false rejection). To overcome these problems, we propose a new method for detecting eyelashes in this paper. This work shows three advantages over previous works. First, because eyelash detection was performed based on focus assessment, its performance was not affected by image blurring. Second, the new focus assessment method is appropriate for iris images. Third, the detected eyelash regions were not used for iris code generation and therefore iris recognition accuracy was greatly enhanced. Experimental results showed that the eyelash detection error was about 0.96% when using the CASIA DB and iris recognition accuracy with eyelash detection was enhanced more than 0.86% of EER when compared to the EER obtained without eyelash detection. [Copyright &y& Elsevier]

Abstract: The ideal solution first recommended is the use of Abbé-Mustardé''s flap with lower lid transposition to rebuild the total loss of the upper eyelid. Every step of the surgical technique has been detailed to improve the result and keep the drawbacks under control. After having read articles on this subject, we describe three clinical cases, which enable us to compare with others surgical techniques that cannot rebuild all the levels of the eyelids and the edge of the eyelashes. [Copyright &y& Elsevier]

Copyright of Canadian Journal of Ophthalmology is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To assess whether iris color and eyelash changes occur with the use of unoprostone for 2 years.Design: The 2 clinical trials described herein were prospective, randomized, double-masked, active-controlled, parallel group, multicenter studies.Participants: A total of 1131 patients with primary open-angle glaucoma or ocular hypertension participated in 2 clinical trials and received either unoprostone isopropyl 0.15% (659), timolol maleate 0.5% (331), or betaxolol hydrochloride 0.5% (141), 1 drop per eye twice daily for up to 24 months.Methods: Color photographs (1:1 magnification) were taken of the iris and eyelid of each patient at baseline and at regular intervals thereafter through month 24 using a standardized camera system. Photography included 7 views of each eye plus a calibration photograph and a patient identification photograph, for a total of 16 photographs per patient per visit. Two independent (masked) readers subjectively compared baseline iris colors to subsequent visits. Side view photographs of the upper and lower eyelashes were used for the eyelash length analysis, with each having sufficient depth of field and a sufficient number of eyelashes in focus. Similarly, frontal eyelash views were used for the eyelash density analysis.Main outcome measures: Changes from baseline in iris color and eyelash length and density within and between treatment groups.Results: Seven cases of iris color change (1.06%) were confirmed in patients treated with unoprostone for up to 24 months; no confirmed cases were reported in the timolol or betaxolol groups. In the unoprostone group, cases of iris color change were confirmed at months 12 (1 case), 18 (2 cases), and 24 (4 cases). No clinically relevant differences were observed among treatment groups for changes from baseline in eyelash length or density.Conclusion: Although iris hyperpigmentation and abnormal eyelash changes may occur after treatment with unoprostone, the incidence of these events appears to be low in the 2-year clinical study. [Copyright &y& Elsevier]