Search

Vernal keratoconjunctivitis (VKC) is a chronic, recurrent, inflammatory disease that affects both eyes, often with asymmetric severity, potentially causing major visual complications. The seasonal management of VKC can be challenging, especially when specialists with different diagnostic and therapeutic approaches need to be consulted. The aim of this expert panel was to reach a national consensus among pediatric allergologists and ophthalmologists on the diagnosis and treatment of VKC. This consensus was developed by an expert panel of 17 Italian pediatric allergologists and ophthalmologists with over a decade of experience. Ten statements on VKC diagnosis and treatment formulated after a thorough review of current literature were evaluated by the panelists. The level of agreement was quantitatively assessed using a 5-point Likert scale. Consensus was reached if ≥ 75.0% of panelists agreed to any given statement. The consensus emphasizes the importance of evaluation by multispecialty reference centers or experienced specialists for accurate diagnosis. Prompt diagnosis, especially during active phases, is crucial and should occur before corticosteroid therapy. The Bonini score from 2007 is the preferred tool for VKC assessment, although future revisions may be considered. Short cycles of topical corticosteroids should be preferred over prolonged use, even during immunomodulatory therapy. When cyclosporine fails, tacrolimus should be considered. Conclusion: This is the first consensus on the management of VKC that has gathered the expert opinions of both pediatricians and ophthalmologists. The outcome of this multidisciplinary effort provides a uniform approach to VKC diagnosis and treatment, thereby facilitating patient management across the country. What is Known: • Vernal keratoconjunctivitis (VKC) is a chronic recurrent ocular disease particularly prevalent in the pediatric population. • Despite its relevance, there is a lack of standardized approaches shared between pediatricians and ophthalmologists, leading to notable variations in clinical practice. What is New: • This expert panel, comprising 17 pediatric allergologists and ophthalmologists, has reached a national consensus to provide standardized guidance for VKC management. • The consensus emphasizes the importance of a multidisciplinary approach to managing VKC, ensuring consistent and effective patient care. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionTo investigate the causal association between gut microbiota and allergic conjunctivitis.A two-sample Mendelian randomization (MR) analysis was performed using the summary statistics of gut microbiota (18,340) from MiBio-Gen consortium and allergic conjunctivitis data (n = 218,792) obtained from the IEU Open GWAS project. F-statistics and sensitivity analyses were used to address potential biases and ensure the reliability of our findings. Reverse MR analysis was conducted to assess the possible of reverse causal relationships.The inverse variance weighted estimates revealed the protective potential of the phylum Euryarchaeota against allergic conjunctivitis (OR = 0.87, p = 6.17 × 10−4). On the other hand, the genus Christensenellaceae R.7 group (OR = 0.75, p = 2.89 × 10−3), family Peptostreptococcaceae (OR = 0.83, p = 6.22 × 10−3), genus Lachnospiraceae FCS020 group (OR = 0.82, p = 0.02) all showed a suggestive protective association with allergic conjunctivitis. Additionally, sensitivity analysis confirmed the robustness of the above associations. In the reverse MR analysis, no significant causal association was found between gut microbiota and allergic conjunctivitis.This study has revealed a potential causal correlation between the phylum Euryarchaeota and allergic conjunctivitis, offering new insights to improve prevention and treatment of this condition. [ABSTRACT FROM AUTHOR]

This article summarizes a real-world study on the use of dupilumab in treating prurigo nodularis (PN). The study examined 64 adult patients with PN and found that dupilumab effectively reduced disease severity and improved symptoms in most patients. Prior to treatment, the patients experienced high disease burden and severe itch. The study suggests that long-term treatment with dupilumab can lead to the resolution of PN. [Extracted from the article]

Copyright of Pamukkale Medical Journal is the property of Pamukkale Journal of Medicine 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.)

The purpose of this study was to improve the efficacy of olopatadine hydrochloride (OT) in treating allergic conjunctivitis (AC). To achieve this goal, we developed an eye formulation without antimicrobial agents using a temperature-pH dual-sensitive in situ gel technology combined with heat sterilization. Various types of carbomers were evaluated and their optimal doses determined. The prescription containing poloxamer 407 (P407) and poloxamer 188 (P188) was optimized using central composite design for response surface methodology (CCD-RSM). The final optimized dual-sensitive in situ gel (TP-gel) consisted of 0.1% olopatadine hydrochloride, 18.80% P407, 0.40% P188, 0.30% Pemulen™TR-1(TR-1), 4.0% mannitol, and 0.08% Tri(hydroxymethyl)aminomethane(Tris).Sterilization was performed at a temperature of 121℃ for a duration of 20 min. Experimental results showed that TP-gel had good safety profile and remained on the ocular surface for approximately (65.83 ± 8.79) minutes, which is four times longer than eye drops. The expression levels of IL-13, IL-17, and OVA-IgE in mouse ocular tissues with allergic conjunctivitis treated with TP-gel were significantly reduced. This suggests that TP-gel has the potential to be an effective treatment method for allergic conjunctivitis. [ABSTRACT FROM AUTHOR]

In recent years, there has been a global increase in the prevalence of allergic diseases, including allergic rhinitis, chronic rhinosinusitis, allergic asthma, atopic dermatitis, allergic conjunctivitis, and food allergies. Since the pathogenic mechanisms of these allergic diseases are not yet fully understood, targeted and effective therapies are lacking. The NLRP3 inflammasome, a multiprotein complex implicated in various inflammatory diseases, can be activated by diverse stimuli. It assembles into NLRP3 inflammasome complexes through conformational changes, initiating the proteolytic cleavage of dormant procaspase-1 into active caspase-1 and promoting the maturation of inflammatory cytokines, including IL-1β and IL-18. Dysfunction of the NLRP3 inflammasome may serve as a key driver of inflammatory diseases, leading to pyroptosis and amplifying the local inflammatory response. As preliminarily demonstrated, specific NLRP3 inflammatory vesicle inhibitors play refectory roles in animal models of allergic diseases, and it is believed that specific NLRP3 inflammasome inhibitors may be potential therapeutic agents for allergic diseases. This review highlights the progress of research on the NLRP3 inflammasome in allergic diseases, explores its contribution to different types of allergic diseases, and identifies promising clinical targets for intervention. [ABSTRACT FROM AUTHOR]

This document is a letter to the editor discussing paradoxical urticaria reactions to H1-antihistamines. The authors report on nine patients with paradoxical urticaria who experienced hives from different classes of H1-antihistamines. The cause of this reaction is still unclear, but it may be related to mast cell degranulation or disruption of the arachidonic acid metabolism pathway. Physicians should be aware of this diagnosis and perform an allergy work-up, including skin testing, in patients suspected of having paradoxical urticaria. The letter includes a table summarizing the clinical characteristics and allergy work-up of the identified cases. [Extracted from the article]

Background: Hay fever (HF) presents with various symptoms, including allergic conjunctivitis and rhinitis, and requires cross‐organ treatment. This study assessed the impact of the coronavirus disease 2019 (COVID‐19) pandemic on HF treatment trends. Methods: This retrospective cohort study utilized data from the JMDC database collected between January 2018 and May 2021. Patients with HF were identified based on the relevant International Classification of Diseases 10th Revision diagnosis codes and the prescription of HF‐related medications. The treatment approaches were compared during the cedar and cypress pollen allergy season (January to May in Japan) before and during the COVID‐19 pandemic (2018 and 2019, and 2020 and 2021, respectively). Results: This study included 2,598,178 patients with HF. The numbers of prescribed HF‐related claims in 2018, 2019, 2020, and 2021 were 3,332,854, 3,534,198, 2,774,380, and 2,786,681 times, respectively. Oral second‐generation antihistamine prescriptions decreased by >10% from 2019 to 2020, with a <10% change in the subsequent year. Anti‐allergic eye drop prescriptions also decreased by >10% from 2019 to 2020 but increased by >10% from 2020 to 2021. Compared with 2018, 2019, and 2020, the number of claims in the rhinitis symptoms dominant group was significantly decreased in 2021 (p < 0.001, all). In contrast, the number of claims in the eye symptoms dominant group and the rhinitis and eye symptoms dominant group increased in 2021 compared with that in 2018, 2019, and 2020 (p < 0.001, all). Conclusion: Changes in HF treatment and related outcomes could be attributed to lifestyle modifications resulting from the COVID‐19 pandemic. Measures, such as limiting outdoor activities and adopting mask‐wearing practices may have influenced HF symptoms, preventive behaviors, and the overall approach to treating HF. [ABSTRACT FROM AUTHOR]

Purpose: To reveal the penetration of epinastine, an anti-allergic ophthalmic agent, into the eyelid and its distribution to the conjunctiva after administration of a cream formulation on rabbit eyelid skin. Study design: Experimental study. Methods: Rabbits were treated with 0.5% epinastine cream on hair-shaved eyelids, followed by preparation of eyelid tissue slices to determine spatial tissue distribution of epinastine by liquid chromatography-tandem mass spectrometry (LC-MS/MS) quantification using laser-microdissected tissues and desorption electrospray ionization mass spectrometry imaging (DESI-MSI). In addition, following either eyelid application of 0.5% epinastine cream or ocular instillation of 0.1% epinastine eye drops, concentration-time profiles of epinastine in the palpebral conjunctiva and bulbar conjunctiva were determined using LC-MS/MS. Results: Laser microdissection coupled with LC-MS/MS analysis detected high concentrations of epinastine around the outermost layer of the eyelid at 0.5 h post-administration that gradually diffused deeper into the eyelid and was distributed in the conjunctival layer at 8 and 24 h post-administration. Similar time-dependent drug distribution was observed in high-spatial-resolution images obtained using DESI-MSI. Epinastine concentrations in the conjunctival tissues peaked at 4–8 h after administration of 0.5% epinastine cream and then decreased slowly over 72 h post-administration. In contrast, epinastine concentrations peaked quickly and decreased sharply after epinastine eye drop administration. Conclusion: After the application of epinastine cream to the eyelid skin, epinastine gradually permeated the eyelid. The compound was retained in the conjunctiva for 8–24 h post-administration, indicating that epinastine cream is a promising long-acting formulation for treating allergic conjunctivitis. [ABSTRACT FROM AUTHOR]

Introduction: The burden of atopic dermatitis (AD) is significant, with a substantial impact on quality of life (QoL). This cross-sectional study aimed to ascertain the burden of AD, its impact on QoL, and associated costs. Methods: Patients with moderate-to-severe AD were enrolled from eight territories, namely Hong Kong, India, Japan, Mainland China, Singapore, South Korea, Taiwan, and Thailand. After screening was performed and informed consent was obtained, eligible participants were asked to provide responses on their AD symptoms, severity, treatment, and out-of-pocket costs via an online survey. QoL was assessed using EQ-5D-5L and Dermatology Life Quality Index (DLQI), while productivity loss was quantified using the Work Productivity and Activity Impairment (WPAI) questionnaire. Data from completed submissions were analyzed using descriptive statistics. The study was reviewed by the institutional review board in each territory. Results: Median age of enrolled patients (N = 1103) was 41.0 years (interquartile range, IQR 16.0). The majority of patients reported that their head/neck, trunk, upper limbs, and lower limbs were affected during a flare. Topical (74.2%) and oral steroids (58.7%) were frequently prescribed to manage AD. Common atopic comorbidities were allergic urticaria (64.2%), allergic rhinitis (61.8%), and allergic conjunctivitis (51.5%). Median DLQI score was 13.0 (IQR 11.0), while median EQ-5D-5L (based on China value set) score was 0.8 (IQR 0.4); 87.2% and 77.2% of patients reported pain/discomfort and anxiety/depression on the EQ-5D-5L domains, respectively. Median total annual costs associated with AD were USD 10,128.52 (IQR 12,963.26) per patient, with indirect costs being the largest component. Findings from WPAI indicated that presenteeism is a major contributor to productivity loss. Conclusion: This multinational survey study showed that AD is associated with substantial QoL impairment and economic burden among Asian adult patients with moderate-to-severe AD. To alleviate burden of AD, clinicians should be more proactive in managing other concomitant conditions including psychological issues, and advocate for increased reimbursement for AD treatments. [ABSTRACT FROM AUTHOR]

Objectives: The present study was to evaluate the prevalence of dry eye disease in patients with different type of allergic conjunctivitis. Methods: A detailed history of demographic characteristics, onset, duration, and progression of ocular symptoms, past and personal history, treatment history and clinical findings were taken to all allergic conjunctivitis patients. The patients of AC were divided into SAC (seasonal allergic conjunctivitis), PAC (perennial allergic conjunctivitis), and VKC (vernal keratoconjunctivitis). Diagnosis of dry eye diseases (DED) in all the diagnosed cases of AC was made based on Ocular Surface Disease Index (OSDI) questionnaire, TFBUT, and Schirmer’s test. Results: A total of 100 diagnosed cases of AC was enrolled. Mean age of male and female cases were 29.76 ± 18.56 years and 17.87 ± 12.32 years respectively. (55%) patients had Seasonal Allergic Conjunctivitis (SAC). 24% patients had Perennial Allergic Conjunctivitis (PAC). And 21% cases had Vernal Keratoconjunctivitis (VKC). Mild, moderate, and severe cases of allergic conjunctivitis were 24%, 18% and 29% respectively. Mean of OSDI score of PAC cases (27.28±13.45) was higher as compared to SAC (24.76± 11.98) and VKC cases (12.56±7.42). Similarly, mean of TFBUT score was higher in SAC cases (16.12± 6.54) as compared to PAC (14.45±7.21) and VKC cases (13.87±5.67). And the mean of Schirmers score as much more higher in VKC cases (23.12±12.76) as compared to PAC (15.54±9.76) and SAC cases (11.86± 6.47). Conclusions: Male population were preponderance to allergic conjunctivitis. Prevalence of dry eye disease is more associated with PAC than SAC and VKC. Hence, we should properly examine allergic conjunctivitis eye for early diagnosis and prompt treatment of dry eye disease. [ABSTRACT FROM AUTHOR]

The objective was to study a large, international, ethnically diverse population of patients with atopic dermatitis (AD) to support the creation of patient-centric recommendations for AD management. Qualitative data were generated from 45-min, 1:1 telephone interviews conducted across 15 countries in each patient's native language. Interviews explored the impact of AD on patients' lives, patients' most important symptoms, treatment expectations, and treatment decision-making. Participants were also questioned on their current knowledge of AD scoring systems and what was most important to include in these tools. In total, 88 adult patients (≥ 18 years old) receiving treatment for AD were recruited through a market research database, clinician referrals, and local advertising. All patients were screened to ensure a balanced and diverse sample in terms of age, gender, educational level, employment status, geographic location, and AD severity. Patients involved in market research or activities supporting advocacy groups within the previous 6 months or affiliated with or employed by pharmaceutical companies were excluded. AD had a substantial impact on patients' lives. Itch, skin redness, and dry/flaky skin were the most frequently reported symptoms, with > 75% of patients experiencing these symptoms every 1–3 days. Mental health issues were common and resulted in the greatest negative impact on patients' daily lives. Patients perceived clinicians to underestimate the burden of their AD. Patients had little awareness of AD scoring systems and indicated a preference for these to be more clearly incorporated in clinical practice. For an ideal scoring system, patients favored using a combination of patient-reported and clinician-reported outcomes to reflect disease burden and ensure consistency across all settings. This global study generated diverse patient perspectives on the disease burden of AD, their expectations of treatment, and their views on AD scoring methods. These data provide evidence to support the development of patient-centric recommendations for AD management. [ABSTRACT FROM AUTHOR]

Large language models (LLMs) like ChatGPT and Bard have the potential to greatly benefit healthcare, including the field of uveitis care. LLMs can provide accessible advice for patients, helping them make decisions about when to seek medical attention or escalate their treatment. They can also assist in the diagnosis of uveitis, although more research specific to uveitis is needed. LLMs can improve the consultation experience by engaging with patients and providing empathetic responses. Additionally, they can aid in medication management and streamline administrative processes. LLMs have the potential to accelerate research in uveitis by automating tasks such as data analysis and identifying potential drug targets. However, there are ethical considerations to address, including patient autonomy, bias, transparency, and accountability. Efforts should be made to ensure equity and accessibility in the implementation of LLMs, and regulatory frameworks should be developed to ensure responsible use. The future directions of LLMs in uveitis care include integrating them with visual and auditory processing and training them in real-time. While LLMs show promise, more research is needed to develop them with reliability and replicability. [Extracted from the article]

Purpose: To assess the effect of anti-allergic therapy on sleep quality of children with allergic conjunctivitis (AC) and their parents. Methods: This prospective single-arm intervention study included 54 AC child-parent dyads. Chinese versions of the Children's Sleep Habits Questionnaire (CSHQ) and Pittsburgh Sleep Quality Index (PSQI) were used to assess the sleep quality of children and their parents, respectively. Results: CSHQ and PSQI total scores were significantly decreased after treatment, with fewer children and parents reporting poor sleep quality. Part impaired sleep behaviors of children and parents can recover to the normal levels. Sleep quality improved greater in children with a severe type of AC, those with worse baseline signs, and without other allergic diseases. For both children and parents, greater improvements in sleep quality were associated with longer treatment duration and with worse baseline sleep quality. Conclusion: Successful management of AC improves sleep quality for both children and their parents. [ABSTRACT FROM AUTHOR]

Purpose: To report a rare case of atopic keratoconjunctivitis (AKC) presenting with bilateral corneal panni associated with limbal inclusion cysts in the left eye. Materials & Methods: Retrospective case report. Results: A 19-year-old female with AKC presented with bilateral corneal panni and limbal inclusion cysts in the left eye. Anterior segment swept-source optical coherence tomography showed bilateral hyperreflective epicorneal membrane and a lobulated cystic lesion in the left eye. Ultrasound biomicroscopy demonstrated a dense membrane overriding the cornea in both eyes and hyporeflective spaces separated by medium reflective septa in the cyst. The patient underwent excision of the limbal inclusion cyst and pannus in the left eye. Histopathological examination revealed subepithelial cystic lesion surrounded by non-keratinizing epithelium; areas of acanthosis, hyperkeratosis, parakeratosis, and hyperplasia in the epithelium of the pannus; as well as inflammation, fibrosis, and increase in vascularization in the stroma. Conclusion: To our knowledge, this is the first case of corneal pannus associated with limbal inclusion cysts in AKC. Surgical excision was done to establish the diagnosis as well as to improve vision in our case. [ABSTRACT FROM AUTHOR]

Objective: To study the ocular effects seen among eye cosmetic wearers in the Indian Population. Methods: This cross-sectional study was conducted on female participants who had fulfilled the inclusion and exclusion criteria. A detailed history was obtained and thorough ophthalmic evaluation was done. Mann Whitney U test was used. Statistical analysis was done using IBM SPSS. p <.05 was taken as the level of statistical significance. Results: Among a total of 225 participants in our study, the mean age was 24.23 ± 1.8, which comprised of young student females. Majority of the females used one eye cosmetic with Kajal (n = 156) being the most predominant. Most frequently encountered symptom upon using eye cosmetics was watering from eyes and ocular pain was the least encountered symptom. Anterior segment examination showed- allergic conjunctivitis and meibomian gland dysfunction being the most and least predominant, respectively. Our study highlights that Kajal predisposes the eyes to significant ocular morbidity with p =.039 for dry eye disease, p =.041 for allergic conjunctivitis, p =.036 for conjunctival pigmentation. Prolonged use of such formulations for more than 4 times a week (p =.046) or even daily (p =.031) for a duration of either 1–5 years (p =.033) or greater than 5 years (p =.027) was found to be statistically significant in causing ocular signs. Non removal of eye cosmetics at the end of the day was significant in causing allergic conjunctivitis (p =.035) and conjunctival pigmentation (p =.021). Plain tap water has been found to be the least effective technique in the removal of such ocular cosmetics with a statistical significance of p =.031 in causing ocular signs. Conclusions: Eye cosmetics are a significant contributor to the development of ocular surface diseases. Removal of products along with decreased usage seems to be a significant contributor in dampening unwanted adverse effects. [ABSTRACT FROM AUTHOR]

Background: Allergic conjunctivitis is increasing with the rise in the levels of allergens. Drug therapy is usually needed in addition to avoidance of general allergens to treat this condition. Both bepotastine besilate and olopatadine hydrochloride ophthalmic solutions are newer additions in the treatment of allergic conjunctivitis having dual properties of second-generation antihistaminics along with mast cell stabilizing activity. Aims and Objectives: The aim of the study was to compare the efficacy and tolerability of bepotastine besilate (1.5%) and olopatadine hydrochloride (0.1%) eye drops in patients presenting with allergic conjunctivitis in a tertiary care hospital of Southern part of India. Materials and Methods: Sixty patients who were clinically diagnosed to be suffering from allergic conjunctivitis were selected as participants for the study. They were randomly distributed into two groups consisting of 30 patients each. One group received eye drop bepotastine (1.5%) and the other group received eye drop olopatadine (0.1%), with each patient receiving the medication twice daily for a duration of 2 weeks. During the first visit, all the patients were assessed for the signs and symptoms and subsequently re-assessed at weekly intervals for a period of 2 weeks. They were also advised to report occurrence of any unwanted drug reaction during the weekly follow-up visits. Results: The above study showed the effectiveness of both bepotastine and olopatadine eye drops in decreasing the signs and symptoms of allergic conjunctivitis. Significant clinical improvement was found in all participants, whereas deterioration was found in none of them. Statistically significant improvement of itching and redness of eyes was observed with use of both the study drugs mentioned beforehand. Both the drugs were well tolerated by the patients. Statistically significant reduction of itching and foreign body sensation was found to be more in patients using bepotastine eye drops compared to those using olopatadine eye drops. Only two patients using bepotastine eye drops complained of having a mild burning sensation in eyes. Conclusion: From this study, bepotastine and olopatadine eye drops have been observed to be safe and efficacious in allergic conjunctivitis. Bepotastine eye drop was found to be more efficacious to relieve itching and foreign body sensation compared to that of olopatadine eye drops.

Allergic conjunctivitis is the most common type of allergic eye disease, and the incidence in children and adolescents is increasing year by year. Drug therapy can only relieve some symptoms and only in a short period, while allergen immunotherapy is currently a therapy that can significantly improve the symptoms of chronic allergy and the course of the disease. This method has been used abroad for many years but has yet to be reported in China. The author reviews the effective mechanism and clinical efficiency of allergen immunotherapy and provides a reference for the further clinical application in China.

Ali S Alsudais,1,2 Waleed Mohammed Alshehri,3 Ahmed M Alrehaili,4 Reyadh Khalid Albeladi,5 Mohammed Khoshhal,4,6 Ahmed Albelowi,4 Raghad Saleh Alzahrani,1,2 Ahmed Alnabihi,1,2 Bader Bashrahil,1,2 Omar Alabbasi3 1College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; 2King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; 3Department of Ophthalmology, King Salman Bin Abdulaziz Medical City, Madinah, Saudi Arabia; 4College of Medicine, Taibah University, Madinah, Saudi Arabia; 5College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 6Ohud Hospital, Madinah, Saudi ArabiaCorrespondence: Ahmed Alnabihi, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, 21423, Saudi Arabia, Tel +966569493360, Email Alnabihi.ahmed@gmail.comObjective: This meta-analysis evaluated the efficacy and safety of DEXTENZA, an intracanalicular dexamethasone insert, for the treatment of seasonal/perennial allergic conjunctivitis.Methods: Multiple databases, including PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, the Directory of Open Access Journals, and Scopus, were searched for randomized controlled trials (RCTs) comparing the efficacy of DEXTENZA with a placebo. The primary efficacy endpoint was the change in the conjunctival allergen challenge (CAC) model. The GRADE approach was used to assess the certainty of evidence, and the revised Cochrane risk of bias tool for randomized trials was employed to assess bias.Results: Four RCTs involving 323 participants met the eligibility criteria, and all had a low risk of bias. A meta-analysis revealed a statistically significant increase in the mean CAC change for conjunctival itching, with low heterogeneity among measurements at 3 minutes (P

Introducion and purpose Millions of people use contact lenses every day. Their primary and most common use is correcting refractive errors. Despite their beneficial purpose, contact lens use has many complications. It is estimated that 5 to 50% of patients may develop at least a single complication. The state of knowledge Contact lens-related complications are multifactorial. One of the main reasons for contact lens discontinuation is contact lens discomfort. Patients most often report dryness, burning, and irritated eyes. Other disorders can be briefly divided into conjunctival and corneal complications. The most common conjunctival and allergic complication of contact lens use is giant papillary conjunctivitis. Other significant conditions involving the conjunctiva can also be superior limbic keratoconjunctivitis or allergic or toxic conjunctivitis. Corneal complications, on the other hand, seemed to be much more severe. These include superficial punctate keratitis, peripheral corneal ulceration, and contact lens-related keratitis. Also, abrasion can occur due to improper eye hygiene or mechanical damage during lens replacement. It should also be remembered that prolonged use of lenses can lead to hypoxia and corneal edema. Summary This paper briefly outlines the possible complications of contact lens use. It is important to remember that despite their appropriate use, sometimes significant complications can occur. Noteworthy, corneal, or conjunctival complications require discontinuation of the lenses and appropriate treatment. [ABSTRACT FROM AUTHOR]

Background: Atopic conditions are known to be associated with viral and bacterial infections. The purpose of this study was to determine the relationship between the effects of atopic conditions on the severity and recurrence of ocular infections including herpes simplex virus (HSV). Methods: This study was performed on 474 consecutive patients with infectious keratitis caused by bacteria, fungus, acanthamoeba, HSV, or varicella-zoster virus. The relationships between the atopic condition and specific infectious pathogens and HSV were determined using real-time PCR. Results: Our findings showed that atopic dermatitis (AD) was significantly associated with the incidence of HSV keratitis (odds ratio (OR), 10.2; P = 0.000). Other associations with AD were observed only with bacteria in an adverse manner. HSV proliferation in the lesions of patients with HSV keratitis whose AD was associated with non-infectious atopic blepharitis were significantly greater by 145-folds (P = 0.000). The presence of asthma or allergic rhinitis also increased the HSV DNA copy numbers.A recurrence of HSV keratitis was observed in 70 patients (43.2 %), and mean time to recurrence was 1647 days. Cox proportional hazard model indicated that the epithelial type of HSV recurrence but not the stromal type was associated with atopic conditions especially with AD. The factors significantly associated with a recurrence was AD associated with non-infectious atopic blepharitis (HR: 6.11, P = 0.000) and asthma (HR: 3.03, P = 0.025). Conclusions: Atopic conditions, especially AD with atopic blepharitis, are significantly associated with the development, increased proliferation, and shorter time to a recurrence on HSV keratitis.

Xiao-Jiao Tang,1– 4 Jia-Tong He,5 Qing Liu,1– 4 Enmei Liu,2– 4,6 Lin Chen1– 4 1Department of Ophthalmology, Children’s Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 2National Clinical Research Center for Child Health and Disorders, Chongqing, People’s Republic of China; 3Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, People’s Republic of China; 4Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, People’s Republic of China; 5Department of Health Management, Chongqing General Hospital, Chongqing, People’s Republic of China; 6Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, Chongqing, People’s Republic of ChinaCorrespondence: Enmei Liu, Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, 136 Zhongshan 2nd Road, Chongqing, Yuzhong District, 400014, People’s Republic of China, Tel +8613368070773, Email emliu186@126.com Lin Chen, Department of Ophthalmology, Children’s Hospital of Chongqing Medical University, 136 Zhongshan 2nd Road, Chongqing, Yuzhong District, 400014, People’s Republic of China, Tel +8618623041022, Email chenlin1220@126.comPurpose: To investigate the patterns of allergens in allergic conjunctivitis (AC) and the association with allergic comorbidity.Methods: This retrospective cross-sectional study enrolled 2972 children with AC. Clinical data, including sex, age, allergic comorbidities (allergic asthma, allergic rhinitis, and atopic dermatitis), and serum allergen-specific immunoglobulin E (sIgE), were collected from the electronic medical record (EMR). The categorical variables were compared with the chi-square test. The characteristics of allergens in children of different ages and comorbidities were analyzed by trend chi-square. The sensitivity level of HDM associated with AC and comorbidities was assessed by odds ratios (ORs) with 95% confidence intervals of logistic regression analysis.Results: A total of 2972 children (2015 boys and 957 girls) with AC were included in the study. The mean age was 3.78 (0.5~12) years. The most common allergen was house dust mite(HDM) (43.41%). With age, the positive rate for inhaled allergens gradually increased, and the positive rate for ingested allergens decreased. With the number of comorbidities increasing, the positive rates of sensitization were 38.33%, 74.51%, 80.72%, and 89.05%, and the incidence of polysensitization was 44.66%, 56.48%, 59.54%, and 74.59%, respectively. With the increase of HDM-sIgE level, the number of comorbidities and the risk increased gradually.Conclusion: HDM is the most common allergen in AC children of different ages. High levels of HDM-sIgE may be a predictor for allergic comorbidities. Children with polysensitization and high levels of HDM sIgE will be an important target population for future intervention in other allergy-related disease prevention.Keywords: allergic conjunctivitis, specific IgE, allergic comorbidity, house dust mite, children

AIM: To evaluate the therapeutic effect of emedastine difumarate eye drops combined with fluorometholone eye drops on allergic conjunctivitis.METHODS: Retrospective study. A total of 115 patients(230 eyes)with allergic conjunctivitis who received treatment from June 2020 to August 2022 were selected, and they were divided into the observation group(56 cases, 112 eyes)and the control group(59 cases, 118 eyes)according to whether to use fluorometholone eye drops combined with the conventional use of emedastine difumarate eye drops. The clinical symptoms and signs, tear film break-up time(BUT), corneal fluorescein staining score and complications of the two groups were observed before treatment and at 4 wk after treatment.RESULTS: After treatment, the scores of eye symptoms and signs in the two groups were decreased, and the observation group was lower than the control group(P0.05).CONCLUSION: With high therapeutic safety and effectiveness, the combination of emedastine difumarate eye drops and fluorometholone eye drops in the treatment of allergic conjunctivitis can significantly reduce the patient's symptom and sign scores, prolong BUT, promote a decrease in corneal fluorescein staining scores, improve efficacy, and do not increase the risk of complications.

This study was designed to formulate a polymeric mixed micelle (PMM) formulation to sustainably release fexofenadine (FEX) to treat allergic conjunctivitis effectively. A 32 factorial design was employed where the studied factors were PL90G amount (X1) and Pluronic (F127 and P123) mixture ratio (X2), and the dependent variables were entrapment efficacy (EE, Y1, %), particle size (PS, Y2, nm), zeta potential (ZP, Y3, mV), and the percent of drug released after 6 h (Q6h, Y4, %). The optimized formula was blended with a hydrogel base to develop an FEX-PMM hydrogel, where the safety and efficiency of this hydrogel were evaluated using in vivo studies. The EE% of FEX-PMM ranged from 62.15 ± 2.75 to 90.25 ± 1.48%, the PS from 291.35 ± 6.43 to 467.95 ± 3.60 nm, the ZP from −5.41 ± 0.12 to −9.23 ± 0.23 mV, and the Q6h from 50.27 ± 1.11 to 95.38 ± 0.92%. The Draize test results confirmed the safety of the FEX-PMM hydrogel. Furthermore, the FEX-PMM hydrogel showed rapid recovery in animals with induced allergic conjunctivitis compared to the free drug hydrogel. These results assure PMM's capability to deliver FEX to the conjunctival surface in a sustained pattern, consequently achieving better therapeutic outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Asthma is associated with upper airway diseases and allergic diseases; however, the causal effects need to be investigated further. Thus, we performed this two-sample Mendelian randomization (MR) analysis to explore and measure the causal effects of asthma on allergic rhinitis (AR), vasomotor rhinitis (VMR), allergic conjunctivitis (AC), atopic dermatitis (AD), and allergic urticaria (AU). Methods: The data for asthma, AR, VMR, AC, AD, and AU were obtained from large-scale genome-wide association studies summarized recently. We defined single-nucleotide polymorphisms satisfying the MR assumptions as instrumental variables. Inverse-variance weighted (IVW) approach under random-effects was applied as the dominant method for causal estimation. The weighted median approach, MR-Egger regression analysis, MR pleiotropy residual sum and outlier test, and leave-one-out sensitivity analysis were performed as sensitivity analysis. Horizontal pleiotropy was measured using MR-Egger regression analysis. Significant causal effects were attempted for replication and meta-analysis. Results: We revealed that asthma had causal effects on AR (IVW, odds ratio [OR] = 1.93; 95% confidence interval [CI], 1.74−2.14; p < 0.001), VMR (IVW, OR = 1.40; 95% CI, 1.15−1.71; p < 0.001), AC (IVW, OR = 1.65; 95% CI, 1.49−1.82; p < 0.001), and AD (IVW, OR = 2.13; 95% CI, 1.82−2.49; p < 0.001). No causal effect of asthma on AU was observed. Sensitivity analysis further assured the robustness of these results. The evaluation of the replication stage and meta-analysis further confirmed the causal effect of asthma on AR (IVW OR = 1.81, 95% CI 1.62–2.02, p < 0.001), AC (IVW OR = 1.44, 95% CI 1.11–1.87, p < 0.001), and AD (IVW OR = 1.85, 95% CI 1.42–2.41, p < 0.001). Conclusions: We revealed and quantified the causal effects of asthma on AR, VMR, AC, and AD. These findings can provide powerful causal evidence of asthma on upper airway diseases and allergic diseases, suggesting that the treatment of asthma should be a preventive and therapeutic strategy for AR, VMR, AC, and AD. [ABSTRACT FROM AUTHOR]

Introduction: Vernal keratoconjunctivitis (VKC) is an allergic disease that predominantly affects young individuals, with a higher incidence among males. Traditionally seen as a condition of childhood that resolves at puberty, recent studies have shown persistent cases in some individuals, potentially influenced by hot and dry tropical environmental conditions. VKC is more prevalent in regions with a hot and humid climate and a high presence of airborne allergens, leading to significant morbidity and impacting the quality of life for affected individuals. Severe and chronic cases can lead to vision‐threatening corneal complications, making effective management crucial. Although the clinical profile of VKC varies geographically, comprehensive studies in specific regions remain limited. Case Presentation: In this case report, we present an 18‐year‐old male patient with severe and refractory VKC. Despite initial treatments, including topical and oral medications, recurrent episodes occurred every 6 months, accompanied by giant papillae (GP) formation and corneal ulcers. The patient had a history of triamcinolone injection and papillectomy combined with amnion membrane transplantation, but presented with a refractory disease in a year. Surgical intervention involving papillectomy and autologous conjunctival membrane graft was performed, leading to a smooth upper tarsal conjunctiva during the 2‐year follow‐up period, without GP recurrence and maintaining a clear cornea. The patient's symptoms were effectively managed with topical medications. Conclusion: The management of VKC necessitates a comprehensive approach involving preventive measures, pharmacological treatment, and surgical interventions for refractory cases. This case highlights the potential benefits of surgical techniques, such as papillectomy and autologous conjunctival membrane graft, in managing severe and refractory VKC cases with a history of previous surgical procedure failure. However, it is essential to recognize that exposure avoidance and allergic control remain fundamental in VKC management. Further research and larger studies are required to validate the efficacy of these surgical techniques in managing VKC. [ABSTRACT FROM AUTHOR]

Objective: To observe the effectiveness and safety of long-term wearing of orthokeratology lens in adolescent myopia patients. Methods: From June 2019 to April 2023, 30 myopic adolescents (60 eyes) who had been fitted with orthokeratology lens in the ophthalmology department of Xuanwu hospital and had worn them for a long time (≥ 3 years) were reviewed. They were reexamined 1 day, 7 days, 1 month and 3 month after wearing the glasses. The changes of the axial length and the parameters of corneal endothelioscopy were compared before and after wearing the glasses for 6 months, 1 year, 2 years and 3 years. Result: A total of 30 cases (60 eyes) were observed in this study, including 13 males and 17 females, aged 7-14 years old, with an average age of 9.77 ± 1.89 years old. The equivalent spherical scope was -5.00-0.75D, with an average of -1.98± 0.97 D. Among them, 5 cases (8 eyes, 13.3%) developed grade 1 corneal staining, but no grade 2-3 staining was observed. 2 cases (4 eyes, 6.7%) developed allergic conjunctivitis, which was cured after stopping wearing and receiving corresponding treatment. The axial lengths of 6 mon, 1 a, 2 a, and 3 a before and after wearing glasses were 24.57± 0.74 mm, 24.67± 0.85 mm, 24.78± 0.96 mm, 24.91± 0.97 mm, and 25.06± 0.85 mm, respectively, showing an overall increasing trend (F=21.904, P<0.001). There were statistically significant differences in axial lengths between pre and post wearing glasses at various time points, with P values of 0.027, 0.001, 0.000, and 0.000, respectively. There was a statistically significant difference between 6 mon after wearing glasses and 1 a, 2 a, and 3 a after wearing glasses. The P-values were 0.005, 0.000, and 0.008, respectively. There was a statistically significant difference (P<0.001) between 1 year after wearing the mirror and 2 years after wearing the mirror, while there was no statistically significant difference (P>0.05) between other time points. The coefficient of variation of cell area at 6 mon, 1 a, 2 a, and 3 a before and after wearing glasses were 25± 2.9%, 26± 3.7%, 27± 4.1%, 27± 4.6%, and 27± 4.1%, respectively. Overall, F=5.490, P=0.001. Comparing the two groups, it was found that there was a statistically significant difference between the two groups, with P values of 0.012 and 0.008, respectively (P<0.05). The difference between the two groups was statistically significant (P=0. 007), There was no statistically significant difference between other time points (P>0.05). There was no statistically significant difference in corneal thickness, endothelial cell density, average area, and hexagonal cell ratio at each time point (P>0.05).Conclusion: Adolescent myopia patients can effectively control the rapid growth of their eye axis by wearing corneal reshaping lenses for a long time. However, comprehensive examination and evaluation must be conducted, qualified and appropriately sized lenses must be worn, standardized operations must be carried out, and follow-up visits must be made on time. If allergies or corneal injuries occur, timely cessation of wearing and corresponding treatment can ensure the safety of long-term wearing. Morphological examination of corneal cells revealed that long-term wearing of glasses showed an increasing trend in the variation of corneal endothelial cell area. [ABSTRACT FROM AUTHOR]

Keratoconus (KC) is a ectatic corneal disorder with marked progression during childhood and puberty that may lead to severe visual loss. Prevalence of keratoconus is variable in different parts of the world. Environmental and ethnic factors and the cohort of patients selected for such studies may explain the wide variation in the reported rates. Family history, gender differences, asymmetry in the two eyes, association with ocular rubbing, and natural history of disease are discussed. Epidemiology of Keratoconus has been classically described as a noninflammatory pathology, characterized by a conical shape of the cornea, as a result of thinning and protrusion. The etiopathogenesis is still under research and it may be the final manifestation of diverse pathologic processes. With better understanding of the disease and new imaging modalities as well as the advent of refractive surgery, it is being diagnosed much more often and much earlier than in the past. Methods: It is a cross sectional study, conducted in our institute National Institute of Medical Sciences, Jaipur from January 2022 to June 2023 for a duration of 18 months, a total of 384 patients attending schools in Jaipur who were selected based on inclusion and exclusion criteria who underwent complete history talking and examination. These patients were subjected to corneal topography. Results: Out of 384 patients, 19 had keratoconus, 46 had VKC (Veneral keratoconjuctivitis), 40 had myopic astigmatism. Conclusion: The incidence of pediatric keratoconus in relation to number of pediatric patient assessed at our hospital was 0.26% and was noted to be higher in our study as compared to other published literature. This can attributed to higher incidence of VKC in the region. [ABSTRACT FROM AUTHOR]

Background: Ocular infections, including conjunctivitis, keratitis, and endophthalmitis, significantly impact eye health, leading to morbidity, visual impairment, and blindness if not treated. Aims and Objectives: This study focuses on reviewing and analyzing the prevalence of bacterial and fungal pathogens in ocular infections and assessing their antimicrobial susceptibility patterns at Vijayanagar Institute of Medical Sciences, Ballari. Materials and Methods: A cross-sectional study was conducted by collecting ocular infection samples from January 01, 2022, to December 31, 2022. Samples, including corneal scrapings and conjunctival swabs, underwent initial procedures such as Gram staining and were inoculated on various agars. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method. Results: Out of 404 evaluated samples, corneal scrapings were predominant, with a significant incidence of fungal and bacterial growth. Aspergillus spp. and Pseudomonas spp. were the most common fungal and bacterial isolates, respectively. Antimicrobial susceptibility testing revealed that Gram-negative bacilli showed more susceptibility to gentamycin, ceftriaxone, and ciprofloxacin, whereas Grampositive cocci were more susceptible to tetracycline and doxycycline. Conclusion: The study highlights the cornea as the most common source of ocular infections, with Aspergillus and Pseudomonas spp. being the predominant fungal and bacterial pathogens, respectively. Identifying the prevalent species in this geographical area aids in early diagnosis and treatment, thereby preventing morbidity and improving patient outcomes. The antimicrobial susceptibility pattern observed suggests effective options for treatment, emphasizing the need for ongoing surveillance to adapt to resistance patterns. [ABSTRACT FROM AUTHOR]

BACKGROUND: Allergic conjunctivitis is one of the most common eye disorders. Different drugs are used for its treatment. Hesperidin is an active substance isolated from Citrus sinensis L. (Rutaceae) fruit peels, with known anti‐inflammatory activity but low solubility. It was complexed with cyclodextrin and encapsulated in situ gel to extend its duration in the eye. RESULTS: The optimized formulation comprised 1% hesperidin, 1.5% hydroxyethyl cellulose, and 16% poloxamer 407. The viscosity at 25 °C was 492 ± 82 cP, and at 35 °C it was 8875 ± 248 cP, the pH was 7.01 ± 0.03, gelation temperature was 34 ± 1.3 °C, and gelation time was 33 ± 1.2 s. There was a 66% in vitro release in the initial 2 h, with a burst effect. A lipoxygenase (LOX) inhibition test determined that hesperidin was active at high doses on leukotyrens seen in the body in allergic diseases. In cell‐culture studies, the hesperidin cyclodextrin complex loaded in situ gel, BRN9‐CD (poloxamer 16%, hydroxy ethyl cellulose (HEC) 1.5%), enhanced cell viability in comparison with the hesperidin solution. It was determined that BRN9‐CD did not cause any irritation in the ocular tissues in the Draize test. CONCLUSION: The findings of this study demonstrate the potential of the in situ gel formulation of hesperidin in terms of ease of application and residence time on the ocular surface. Due to its notable LOX inhibition activity and positive outcomes in the in vivo Draize test, it appears promising for incorporation into pharmaceutical formulations. © 2024 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry. [ABSTRACT FROM AUTHOR]

Background: The prevalence of contact allergy to various ophthalmic medications appears to be rare; however, data on culprits, clinical relevance of sensitizations, and changes in frequency within recent decades are limited. Objective: This study aimed to investigate the clinical relevance, risk factors, and prevalence of contact allergy to topical ophthalmic medications in patients suspected of allergic contact dermatitis to ophthalmic medication. Methods: We retrospectively analysed patch test results and clinical data for 754 patients patch‐tested with an ophthalmic medication series at our tertiary referral centre between January 1992 and December 2022. Results: In total, 37.5% (283/754) of patch‐tested patients had a contact allergy to at least one ophthalmic allergen, with 87.3% (247) being clinically relevant sensitization. Phenylephrine (31.8%, 192/604), povidone‐iodine (29%, 27/93), and tobramycin (23%, 46/200) were the most important sensitizers. The incidence of contact allergies increased significantly in a linear manner (p = 0.008) from 20% to 44.1% within the study period. Male sex and age above 40 were risk factors for contact allergy to ophthalmic medication. Conclusions: One third of patch tested patients had allergic contact dermatitis to ophthalmic medication, particularly phenylephrine. Male sex and age above 40 years were independent risk factors and drove the linear increase in contact allergy to ophthalmic medications within the past 31 years. [ABSTRACT FROM AUTHOR]

Conjunctivitis caused by viruses, bacteria, or allergies is one of the most common eye conditions in primary care. There is no single sign or symptom that accurately differentiates viral from bacterial conjunctivitis. A comprehensive history and physical examination can guide diagnosis. Viral and allergic conjunctivitis are more common in adults and typically present with watery discharge. Supportive care options for viral conjunctivitis include artificial tears, cold compresses, and antihistamine eye drops. Strict personal hygiene, including frequent handwashing, is essential to decrease the risk of transmission. Topical antihistamines with mast cell–stabilizing activity are the treatment of choice for allergic conjunctivitis. Bacterial conjunctivitis is more common in children and typically presents as mucopurulent discharge with the eyelids matted shut. Delayed antibiotic prescribing has been found to have similar symptom control as immediate prescribing. Ophthalmology referral is indicated for conjunctivitis in a neonate or patients with severe pain, decreased vision, recent ocular surgery, vesicular rash on the eyelids or nose, history of rheumatologic disease, or immunocompromised state. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to establish a mouse model of allergic rhinoconjunctivitis and investigate the role of the NLRP3 signaling pathway in allergic rhinoconjunctivitis. Methods Thirty-three female C57 mice (SPF) were randomLy divided into 3 groups: the control group, the experimental group, and the NLRP3-/- group. On days 0, 4, 7, 14, and 21, the experimental group and NLRP3-/- group received a 0.2 mL intraperitoneal injection of medicine containing OVA (100 μg) and adjuvant Al (OH) 3 (4 mg), respectively. After an interval of 3 days, each eye and nose were dosed with 10 μL of 5% OVA for five consecutive days a week to induce allergic symptoms. During sensitization and excitation stages, the control group was replaced with an equivalent amount of PBS. Ocular and nasal symptoms were observed and scored. The levels of OVA-specific IgE, IL-4, IL-17, and IL-18 in serum were measured using ELISA, while changes in palpebral conjunctiva and nasal mucosa were assessed by hematoxylin-eosin staining. The expression of NLRP3 mRNA in conjunctival tissue and nasal mucosa was determined using real-time PCR analysis. Statistical analysis was performed using SPSS17.0 software with P < 0.05 considered as statistically significant difference. Results The experimental group and NLRP3-/- group exhibited induced nasal and ocular allergic symptoms. In the experimental group, the duration of nasal allergy symptoms was (10.500 ± 1.080) days, while the duration of eye allergy symptoms was (20.300 ± 2.058) days. In the NLRP3-/- group, the duration of nasal allergy symptoms was (13.400 ± 1.955) days, and for eye allergy symptoms it was (20.900 ± 2.132) days. The duration of nasal allergies in the NLRP3-/- group significantly exceeded that in the experimental group (P < 0.05), whereas there were no significant differences observed in eye allergy durations between these two groups (P > 0.05) . Levels of OVA-specific IgE, IL-4, and IL-17 were significantly higher in both the experimental and NLRP3-/- groups compared to those in the control group (P < 0.05) . Additionally, serum IL-18 content increased significantly in the experimental group when compared with both control and NLRP3-/- groups (P < 0.05) . Conjunctival tissue lesions as well as nasal mucosa damage were evident in both experimental and NLRP3-/- groups. mRNA expression levels of NLRP3 within conjunctival tissue and nasal mucosa from the experimental group showed a significant increase when compared to those from both control and NLRP3-/- groups (P < 0.05) . Conclusion Allergic rhinoconjunctivitis pathogenesis is influenced by various factors, however, the involvement of NLPR3 signaling pathway promotes its development. [ABSTRACT FROM AUTHOR]

We investigated the relationship between subjective symptoms and objective findings in patients with allergic conjunctival diseases (ACD) and test results for tear total IgE (t-tIgE), conjunctival eosinophils (c-Eo), serum total IgE (s-tIgE), serum-antigen specific IgE (s-sIgE), and serum eosinophils (s-Eo). Subjective symptoms and objective findings of patients with ACD were evaluated using Japanese Allergic Conjunctival Disease Quality of Life Questionnaire (JACQLQ), which described disability score and emotional score written by patient and clinical findings score written by ophthalmologist. We investigated the relationship between questionnaire scores and laboratory data for t-tIgE, c-Eo, s-tIgE, s-sIgE, and s-Eo. Scores of impediments to life and of moods were highest in vernal keratoconjunctivitis among ACD. Cases with positive pollen-sIgE showed significantly more nasal symptom score than those with negative pollen-sIgE (P < 0.05). Cases with positive t-tIgE or c-Eo showed significantly more objective symptoms' JACQLQ score than those with negative t-tIgE or c-Eo (P < 0.05), respectively. Cases positive for house dust/mite-sIgE, showed significantly more objective symptoms' JACQLQ score than those without for house dust/mite-sIgE (P < 0.05). These results indicate that ACD could be analyzed more accurately by the combination of JACQLQ and laboratory data. [ABSTRACT FROM AUTHOR]

The article explores the potential benefits of probiotic bacteria and their byproducts in preventing allergic inflammation in the airways and gut. The study used a mouse model to investigate the effects of a commercially available probiotic formulation called BactoFlor® 10/20, which contains specific strains of Lacto- and Bifidobacteria, as well as the prebiotic carbohydrate inulin. The results showed that oral administration of BactoFlor® 10/20 or butyrate effectively prevented gut and lung inflammation in the mice. The study also found an increase in regulatory T cells in the lung and gut tissue of the treated mice, suggesting that these cells may contribute to the protective effect of the probiotics. Overall, the findings contribute to our understanding of the potential immune-modulating effects of probiotics in preventing allergic diseases. [Extracted from the article]

Background: Glaucoma treatment often involves multi-drug regimens, which can lead to poor adherence and side effects. Fixed-dose combinations aim to improve adherence and reduce side effects compared to traditional therapies. This study aimed to compare the prevalence and clinical characteristics of ocular allergy in glaucoma patients using brinzolamide 1.0%/brimonidine 0.2% fixed combination (BBFC), with and without concurrent β-blocker. Methods: Of these, 176 patients used a β-blocker concurrently, whereas 96 patients did not. Allergy prevalence, allergy type, and allergy occurrence time were compared between the concurrent and non-concurrent β-blocker-usage groups. Ocular allergies were classified and evaluated using Kaplan–Meier survival analysis. Results: Allergy prevalence was 10.23% and 15.63% (p = 0.193), whereas allergy occurrence time was 15.92 ± 13.80 months and 6.26 ± 6.20 months (p = 0.04) in the concurrent and non-concurrent β-blocker-usage groups, respectively. Kaplan–Meier survival analysis indicated that half of the allergies in the concurrent β-blocker-usage group occurred within 12.5 months, with the BBFC discontinuation rate gradually increasing up to 36 months. Contrarily, half of the allergies in the non-concurrent β-blocker-usage group occurred within 3.3 months, with a rapid increase in BBFC discontinuation rate the first 6 months. Intergroup differences in allergy types were significant (p = 0.015). Among all patients with allergy, the average allergy occurrence time of blepharoconjunctivitis, papillary conjunctivitis, and follicular conjunctivitis was 12.52, 9.53, and 13.23 months, respectively. Follicular conjunctivitis tended to occur later than papillary conjunctivitis (p = 0.042). In the concurrent β-blocker-usage group, follicular conjunctivitis was the most prevalent allergy type (61.1%), whereas papillary conjunctivitis was the most common (66.7%) in in the non-concurrent β-blocker-usage group. Conclusions: Concurrent use of β-blocker with BBFC decreases allergy prevalence, delays allergy onset, and predominantly results in follicular conjunctivitis, thereby facilitating longer treatment duration. Understanding these characteristics of allergy in BBFC users is useful to manage patients and improve treatment adherence. This study provides insights into the role of β-blockers in modulating ocular allergy in BBFC-treated glaucoma patients, highlighting implications for clinical practice and patient education. [ABSTRACT FROM AUTHOR]

This case report highlights a unique presentation of Erdheim-Chester Disease (ECD) with bilateral scleral lesions, choroidal infiltration, and extensive sinus involvement. It is the first case report where the diagnosis was confirmed through a scleral biopsy after an initial presentation of a unilateral nodular scleritis. There was a gradual disease progression and ocular examination later revealed bilateral subconjunctival hyperemic lesions and mild exophthalmos, ophthalmoplegia, and extensive choroidal infiltration. Infiltration of the frontal and maxillary sinus was present and extended into the nasal cavity and both orbits. The diagnostic work-up is described in detail. Current treatment options are analyzed. It is emphasized that the ophthalmologist can play a crucial role in the diagnosis of ECD, given the substantial prevalence of orbital and ocular symptoms. The overall prognosis for ECD remains unfavorable, particularly in cases with orbital involvement. This case underscores the complexity and importance of a multidisciplinary approach in managing ECD. [ABSTRACT FROM AUTHOR]

Background: To study the levels of vitamin D serum levels in children with vernal keratoconjuctivits (VKC) and comparing vitamin D levels in after giving vitamin D supplements between intervention and control group. Methods: The study was conducted in population between 1 to 12 years in tertiary care hospital in North India. Amongst children with VKC, full ocular examination along with Boninis clinical grading of VKC and serum vitamin D levels were assessed. Whole study group was randomly divided into two groups. Intervention group had received vitamin D powder while control group kept under observation. Results: A total of 88 children received vitamin D supplementation and 39 kept in control group. Conclusion: Our study suggests that children in intervention group showed improvement in serum vitamin D levels with the clinical improvement in VKC grading too. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the incidence, clinical features, treatment, and outcome of canine follicular conjunctivitis (CFC). Procedure: Medical records of dogs diagnosed with CFC were reviewed. Data recorded included signalment, duration of clinical signs and treatment details prior to presentation, concurrent ocular/systemic diseases, ocular clinical signs, cytology, treatment, follow‐up, and outcome. Blepharospasm, signs of self‐trauma, hyperemia, chemosis, ocular discharge, and follicle location and severity (0.5–4) were retrospectively evaluated. Based on severity, treatment consisted of topical 0.1% diclofenac or 0.1% dexamethasone sodium eyedrops. Dogs were classified into young (YD < 18 months) and adult (AD ≥ 18 months). Results: One hundred and fifty‐three dogs (276 eyes) were included in the study: 83YD (54%) and 70AD (46%). Males and bilateral disease were over‐represented in both groups. Severity was associated with young age (p =.032) and bilaterality (p =.025), and not with dermatological diseases (p >.05). No differences in follicular location were observed except for more frequent involvement of the nictitating membrane (MN) in YD (p =.02). Response to treatment was faster in AD (p =.001), with complete resolution in 80.6% of the eyes (100/124) at 1 month. YD treated with diclofenac showed faster resolution than those treated with 0.1% dexamethasone (p =.009). Conclusions: Although CFC is a bilateral ocular disease occurring at any age, the clinical presentation is influenced by age. Follicular conjunctivitis in adult dogs is less sever, less commonly affects the NM, and responds more quickly to topical treatment. One month of topical diclofenac may be adequate for mild cases, and 1 month of topical 0.1% dexamethasone is recommended as initial therapy for moderate to severely affected cases. [ABSTRACT FROM AUTHOR]

Background: Ambient pollen exposure causes nasal, ocular, and pulmonary symptoms in allergic individuals, but the shape of the exposure–response association is not well characterized. We evaluated this association and determined (1) whether symptom severity differs between subpopulations; (2) how the association changes over the course of the pollen season; and (3) which pollen exposure time lags affect symptoms. Methods: Adult study participants (n = 396) repeatedly scored severity of nasal, ocular, and pulmonary allergic symptoms, resulting in three composite symptom scores. We calculated hourly individually relevant pollen exposure to seven allergenic plants (alder, ash, birch, hazel, grasses, mugwort, and ragweed) considering personal sensitization and exposure time lags of up to 96 h. We fitted generalized additive mixed models, with a random personal intercept, adjusting for weather and air pollution as potential time‐varying confounders. Results: We identified a clear nonlinear positive association between pollen exposure and ocular and nasal symptom severity in the pollen allergy group: Symptom severity increased steeply with increasing exposure initially, but attenuated beyond approximately 80 pollen/m3. We found no evidence of an exposure threshold, below which no symptoms occur. While recent pollen exposure in the last approximately 5 h affected symptoms most, associations lingered for up to 60 h. Grass pollen exposure (compared to tree pollen) and younger age (18–30 years, as opposed to 30–65 years) were both associated with higher nasal and ocular symptom severity. Conclusions: The lack of a threshold and attenuated dose–response curve may have implications for pollen warning systems, which may be revised to include multiday pollen concentrations in the future. [ABSTRACT FROM AUTHOR]

Purpose: To elucidate the efficacy and safety profile of interferon α‑2b in vernal keratoconjunctivitis (VKC). Methods: In this prospective interventional study, VKC patients fulfilling the inclusion and exclusion criteria were included and their signs and symptoms were scored based on the Clinical Scoring System. Patients were treated with topical interferon α‑2b eye drop (1 MIU/ml) QID dosing for 6 weeks. Changes in symptoms and signs were evaluated at 2, 4, 8 weeks and 6 months after initiating treatment. A higher score meant severe disease, and a decline in score meant improvement in clinical signs and symptoms. Categorical variables were presented in number and percentage (%) and continuous variables as mean ± standard deviation (SD). Post‑medication total subjective symptom score (TSSS) and total objective sign score (TOSS) were compared with baseline, and a P- value of <0.05 was considered significant. Possible ocular and systemic complications were evaluated. Results: The study included 40 patients (32 male and eight female) with a mean age of 8.05 ± 2.33 years. Mean baseline TSSS and TOSS were 6.71 ± 0.564 and 6.59 ± 0.262, respectively, which reduced to 2.71 ± 0.011 (P = 0.040) and 2.96 ± 0.210 (P = 0.032), respectively, at 4 weeks and further reduced to 0.42 ± 0.552 and 0.47 ± 0.434, respectively, at 8 weeks. After 6 months of stopping the drug, mean TSSS and TOSS did increase to 2.80 ± 0.820 (P = 0.044) and 2.50 ± 0.520 (P = 0.030), respectively, but was still statistically significant improvement compared to the baseline. Also, no ocular or systemic side effects were observed anytime during the study period. Conclusion: Eye drop interferon α‑2b (1 million IU/ml) is a safe and effective option as first‑line monotherapy for VKC. No side effects and recurrence were observed for 6 months. [ABSTRACT FROM AUTHOR]

Allergy to fur animals is becoming an increasingly common clinical problem in everyday medical practice. Depending on the route of exposure to the allergen, patients present with many, often non-specific symptoms. The most common illnesses among people with allergies to the above-mentioned allergens are as follows: allergic rhinitis, allergic conjunctivitis, atopic bronchial asthma, food allergy, allergic contact dermatitis, and sometimes anaphylactic shock. In recent years, there has been a change in the holistic approach to the treatment of allergy patients. The method of treatment should be tailored to a specific patient, taking into account his or her predispositions, economic possibilities, and therapeutic goals. The article describes the main methods of treating allergies, focusing primarily on allergies to fur animals. Allergy treatment always requires great care, and qualification for specific types of therapy should be preceded by a thorough and accurate diagnosis. [ABSTRACT FROM AUTHOR]

Atopic conditions are known to be associated with viral and bacterial infections. The purpose of this study was to determine the relationship between the effects of atopic conditions on the severity and recurrence of ocular infections including herpes simplex virus (HSV). This study was performed on 474 consecutive patients with infectious keratitis caused by bacteria, fungus, acanthamoeba, HSV, or varicella-zoster virus. The relationships between the atopic condition and specific infectious pathogens and HSV were determined using real-time PCR. Our findings showed that atopic dermatitis (AD) was significantly associated with the incidence of HSV keratitis (odds ratio (OR), 10.2; P = 0.000). Other associations with AD were observed only with bacteria in an adverse manner. HSV proliferation in the lesions of patients with HSV keratitis whose AD was associated with non-infectious atopic blepharitis were significantly greater by 145-folds (P = 0.000). The presence of asthma or allergic rhinitis also increased the HSV DNA copy numbers. A recurrence of HSV keratitis was observed in 70 patients (43.2 %), and mean time to recurrence was 1647 days. Cox proportional hazard model indicated that the epithelial type of HSV recurrence but not the stromal type was associated with atopic conditions especially with AD. The factors significantly associated with a recurrence was AD associated with non-infectious atopic blepharitis (HR: 6.11, P = 0.000) and asthma (HR: 3.03, P = 0.025). Atopic conditions, especially AD with atopic blepharitis, are significantly associated with the development, increased proliferation, and shorter time to a recurrence on HSV keratitis. [ABSTRACT FROM AUTHOR]

This study investigates the description of skin hydration levels and allergic contact dermatitis in students using hand sanitizers at the Faculty of Medicine, Tarumanagara University class of 2021. This research uses a descriptive approach with a cross-sectional study design. Data was collected from January to May 2024 using questionnaires and tools to measure skin hydration levels. The results showed that the majority of subjects had normal skin hydration levels, but some experienced very dry or dry conditions. As many as 19% of subjects experienced allergic contact dermatitis, with the majority being women. This condition affects the performance of hand skin, especially in hand sanitizer users. [ABSTRACT FROM AUTHOR]

Myopia is regarded as a worldwide epidemic ocular disease, has been proved related to inflammation. CD55, also known as decay-accelerating factor (DAF) can modulate the activation of complement through inhibiting the formation of complement 3 convertase and its dysregulation is involved in various inflammatory diseases. To investigate the association between CD55 and myopia, and to test whether CD55 can inhibit myopia development by suppressing inflammation in the eye, we use three different animal models including monocular form-deprivation myopia, myopia induced by TNF-α administration and allergic conjunctivitis animal model to reveal the CD55 in myopia development. The tears of thirty-eight participants with different spherical equivalents were collected and CD55 in the tears were also analyzed. Complement 3 and complement 5 levels increased while CD55 levels decreased in allergic conjunctivitis and myopic eyes. After anti-inflammatory drugs administration, CD55 expression was increased in monocular form-deprivation myopia model. We also found inflammatory cytokines TGF-β, IL-6, TNF-α, and IL-1β may enhance complement 3 and complement 5 activation while CD55 level was suppressed contrary. Moreover, lower CD55 levels were found in the tears of patients with myopia with decreased diopter values. Finally, CD55-Fc administration on the eyelids can inhibit the elongation of axial length and change of refractive error. CD55-Fc application also suppress myopia development subsequent to complement 3 and complement 5 reduction and can lower myopia-specific (MMP-2 and TGF-β) cytokine expression in TNF-α induced myopia animal model. This suggests that CD55 can inhibit myopia development by suppression of complement activation and eventual down-regulation of inflammation. • CD55-Fc administration kept down the elongation of axial length and the change if refractive error in myopic eyes. • CD55 expression decreased in tears pf patients with higher spherical equivalent. • Activation of complementary system and inflammatory cytokines were involved in myopia development. • CD55 can inhibit myopia development via suppressing the complementary system and downregulating the inflammation. [ABSTRACT FROM AUTHOR]

The incidence of vernal keratoconjunctivitis (VKC) varies across different ethnicities and regions. To investigate the clinical features of VKC in Tibet, a single-center case series of VKC was retrospectively reviewed from a general hospital in Lhasa over one year. General data and typical manifestations were recorded. Horner–Trantas dots, limbal neovascularization, pseudogerontoxon and upper palpebral conjunctival papilla were seen in most of these patients. Patients with signs such as limbal pannus (t = 2.18, P < 0.05), pseudogerontoxon (t = 2.61, P < 0.05), and Horner–Trantas dots (t = 2.33, P < 0.05) appeared to have longer disease courses, while patients with upper palpebral conjunctival lesions had earlier onset times (t = 2.12, P < 0.05). The clinical signs of VKC on the Tibetan Plateau are more obvious, and the ocular surface is commonly and severely involved. [ABSTRACT FROM AUTHOR]

Background: Vernal keratoconjunctivitis (VKC), a chronic and bilateral allergic eye condition, predominantly affects young males and is more prevalent in hot, humid regions with high allergen exposure. It manifests with itching, light sensitivity, burning sensations, and tearing. The three main clinical forms include limbal or bulbar, palpebral or tarsal, and mixed presentations. Aims and Objectives: This study aimed to describe the clinical patterns of VKC in children at a tertiary care hospital in Andhra Pradesh. Materials and Methods: This cross-sectional observational study was conducted in a hospital setting at the Department of Ophthalmology, SV Medical College in Tirupati, Andhra Pradesh, between January 2021 and January 2022. Ninety children aged 5–12 years with symptoms of allergic conjunctivitis were enrolled in the study. The Bonini grading system was used to grade the severity of the disease based on clinical manifestations at the time of initial presentation. Results: Mean age of disease onset was 8.6±2.3 years, with a male-to-female ratio (M: F) of 2.1:1. The majority of the subjects experienced seasonal occurrence 69 (77.0%), whereas 21 (23%) had perennial occurrence. The commonly reported symptoms included itching (83%), redness (73%), watering (73%), and discharge (47%). A significant number of patients (60, 69%) had a mixed type of disease that affected both the tarsal and bulbar conjunctiva. Conclusion: VKC predominantly affects young males, displaying a seasonal distribution and showing less allergic association, consistent with patterns observed in other tropical regions. Most patients had mild VKC at presentation, and a mixed-form pattern was most frequently observed. [ABSTRACT FROM AUTHOR]

Purpose: To better understand the patient journey and challenges in the diagnosis and treatment of patients with vernal keratoconjunctivitis (VKC). Methods: This qualitative study assessed the experience of caregivers of children with VKC (n = 7) and of clinicians who treat VKC (n = 16) in the United States. The structured interviews were conducted to identify key "pain points", obstacles, and trends on the path to diagnosis. Results: Like an earlier study conducted in the United Kingdom, this study found low awareness of the nature and severity of VKC among U.S. caregivers and non-specialist providers, and a tendency among young patients and their caregivers to downplay initial symptoms. Medical intervention was delayed as caregivers treated symptoms with over-the-counter medications; 88% (14 of 16) of specialists reported frequent misdiagnosis and mistreatment by pediatricians and primary care providers who were initial points of care. Time to appropriate referral ranged from 1 to 2 weeks to 3 months, in part due to convoluted referral pathways that were universal points of frustration for caregivers and specialists. Conclusions: Limited awareness of VKC remains a barrier to timely identification and management of this rare but disruptive ocular surface disease. Caregivers underestimate symptom severity, pediatricians and primary care providers often misdiagnose VKC as allergy or infection, and referrals to appropriate specialists are delayed until symptoms are severe. Early identification is essential to improving the diagnostic journey and treatment of VKC. [J Pediatr Ophthalmol Strabismus. 2024;61(4):252–256.] [ABSTRACT FROM AUTHOR]

Purpose of Review: The aim of this review, is to present an updated revision of topical management of SAC and PAC, based on the available scientific evidence and focused on the impact of ophthalmic solution formulations on eye surface. Recent Findings: Physicians treating ocular allergy should be aware of tear film and tear film disruption in SAC and PAC, and how eye drop composition and additives affect the physiology of the allergic eye. Summary: Seasonal and perennial allergic conjunctivitis (SAC and PAC) are the most frequent causes of ocular allergy (OA), and both conditions are underdiagnosed and undertreated. SAC and PAC are immunoglobulin E (IgE)-mediated hypersensitivity reactions. The additional tear film disruption caused by the release of inflammatory mediators increases and exacerbates the impact of signs and symptoms and may trigger damage of the ocular surface. Comorbidities are frequent, and dry eye disease in particular must be considered. Clinical guidelines for the management of SAC and PAC recommend topical therapy with antihistamines, mast cells stabilizers or dualaction agents as first-line treatment, but care should be taken, as many medications contain other compounds that may contribute to ocular surface damage. [ABSTRACT FROM AUTHOR]