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Abstract Background Scorpion envenomation, a prevalent medical emergency in rural areas, demands immediate attention due to its potential severity. While ocular manifestations are uncommon, they can lead to significant complications such as corneal ulceration. We present a unique case of corneal ulceration subsequent to a yellow scorpion (Hemiscorpius lepturus) sting near the eye, a scenario not previously documented. Case presentation A 34-year-old male sought medical care following a scorpion sting despite prior anti-venom treatment. Clinical examination revealed pronounced ocular inflammation, corneal stromal melting, and anterior chamber inflammation, with microbiological confirmation of Pseudomonas spp infection. Treatment comprised fortified ceftazidime and vancomycin eye drops, alongside topical corticosteroids, leading to visual and corneal healing. Conclusion This case highlights the urgency of addressing scorpion envenomation and its potential for severe ocular complications, including corneal ulceration. Prompt diagnosis and targeted therapy with antibiotics and corticosteroids are crucial for favorable outcomes. A comprehensive understanding and timely intervention in scorpion sting-induced ocular manifestations are essential for optimal patient management and outcomes in such cases.

Background: Scorpion envenomation, a prevalent medical emergency in rural areas, demands immediate attention due to its potential severity. While ocular manifestations are uncommon, they can lead to significant complications such as corneal ulceration. We present a unique case of corneal ulceration subsequent to a yellow scorpion (Hemiscorpius lepturus) sting near the eye, a scenario not previously documented. Case presentation: A 34-year-old male sought medical care following a scorpion sting despite prior anti-venom treatment. Clinical examination revealed pronounced ocular inflammation, corneal stromal melting, and anterior chamber inflammation, with microbiological confirmation of Pseudomonas spp infection. Treatment comprised fortified ceftazidime and vancomycin eye drops, alongside topical corticosteroids, leading to visual and corneal healing. Conclusion: This case highlights the urgency of addressing scorpion envenomation and its potential for severe ocular complications, including corneal ulceration. Prompt diagnosis and targeted therapy with antibiotics and corticosteroids are crucial for favorable outcomes. A comprehensive understanding and timely intervention in scorpion sting-induced ocular manifestations are essential for optimal patient management and outcomes in such cases. [ABSTRACT FROM AUTHOR]

Introduction: Canine bacterial keratitis is a corneal infection that causes various symptoms, including visual impairment, and necessitates eye removal in severe cases. Staphylococcus pseudintermedius is a pathogen that causes significant bacterial keratitis in canine patients. Moreover, multi-drug resistant Staphylococcus pseudintermedius (MDRSP) has been reported in both humans and animals. Regarding treatment failure against multi-drug resistant (MDR) pathogens with classic antibiotics, antimicrobial compounds derived from probiotics have been suggested as an alternative approach. Methods: Ligilactobacillus animalis SWLA-1 strain and its cell-free supernatant (CFS) have previously demonstrated potent antimicrobial activity against various MDR pathogenic bacteria. Based on this finding, we evaluated the antistaphylococcal activity of CFS derived from Ligilactobacillus animalis SWLA-1 against MDRSP in a newly established ex vivo canine corneal infection model using fresh canine corneoscleral rims. Additionally, an in vitro cytotoxicity test using human keratocytes was performed. Results and Discussion: CFS significantly inhibited the growth of MDRSP in the novel ex vivo model and did not exhibit any significant toxicity against keratocytes in vitro. Based on these results, the antimicrobial compounds in CFS show potential as a novel approach for MDR staphylococcal keratitis treatment. [ABSTRACT FROM AUTHOR]

Objective Procedures Results Conclusions To report risk factors associated with conjunctival graft failure in dogs at four referral specialty centers.Records of 203 dogs (229 eyes) undergoing conjunctival graft repair of ulcerative keratitis at four hospitals from 2015 to 2021 were reviewed. Success was defined as full graft integration with globe retention at the last postoperative evaluation; vision status was reported separately. Factors assessed included patient signalment, ophthalmic examination findings, surgical factors, and follow‐up information.Conjunctival graft failure occurred in 11% (25/229) of eyes and was significantly associated with ulcer depth, with corneal perforations having increased odds of graft failure compared with descemetoceles (odds ratio [OR] = 3.22, 95% confidence interval [CI] 1.11–9.32; p = .03) and stromal ulcers (OR = 10.89 [95% CI 1.38–86.18], p = .02). Brachycephalic dogs were significantly more likely than non‐brachycephalic dogs to experience graft failure (OR = 5.02 [95% CI 1.42–17.74], p < .01). Surgery on the opposite eye relative to surgeon handedness was significantly associated with an increased risk of graft failure (OR 4.28 [95% CI 1.53–11.94], p < .01). The use of 7‐0 and 8‐0 suture versus 9‐0 (p = .03) and the use of a combined simple continuous and interrupted pattern (p = .03) were significantly associated with an increased risk of graft failure. At the last follow‐up, (median 61.5 days), 87% of dogs were visual.Corneal perforations, surgery on the opposite eye relative to surgeon handedness, suture size and pattern, and brachycephalic conformation were significantly associated with an increased risk of graft failure in this study. These characteristics can be considered when determining prognosis for ulcerative keratitis requiring surgical intervention. [ABSTRACT FROM AUTHOR]

Microbial keratitis (MK) is a potentially blinding corneal disease caused by an array of microbial etiologies. However, the lack of early organism identification is a barrier to optimal care. We investigated clinician confidence in their diagnosis of organism type on initial presentation and the relationship between confidence and presenting features. This research presents secondary data analysis of 72 patients from the Automated Quantitative Ulcer Analysis (AQUA) study. Cornea specialists reported their confidence in organism identification. Presenting sample characteristics were recorded including patient demographics, health history, infection morphology, symptoms, and circumstances of infection. The association between confidence and presenting characteristics was investigated with 2-sample t-tests, Wilcoxon tests, and Chi-square or Fisher's exact tests. Clinicians reported being "confident or very confident" in their diagnosis of the causal organism in MK infections for 39 patients (54%) and "not confident" for 33 patients (46%). Confidence was not significantly associated with patient demographics, morphologic features, or symptoms related to MK. MK cases where clinicians reported they were confident, versus not confident in their diagnosis, showed significantly smaller percentages of previous corneal disease (0% versus 15%, p = 0.017), were not seen by an outside provider first (69% versus 94%, p = 0.015), or had no prior labs drawn (8% versus 33%, p = 0.046), and a significantly larger percentage of cases wore contact lenses (54% versus 28%, p = 0.029). In almost half of MK cases, cornea specialists reported lack of confidence in identifying the infection type. Confidence was related to ocular history and circumstances of infection but not by observable signs and symptoms or patient demographics. Tools are needed to assist clinicians with early diagnosis of MK infection type to expedite care and healing. [ABSTRACT FROM AUTHOR]

Inflammatory complications of cataract phacoemulsification are among the most urgent and potentially vision-threatening conditions. Corneal melting is a rare but clinically significant condition preceding corneal perforation. The main risk factors are the use of nonsteroidal anti-inflammatory drugs (NSAIDs), severe dry eye disease and rheumatic diseases. The paper presents a literature review and offers an analysis of a clinical case of corneal melting after cataract phacoemulsification in a female patient with severe dry eye disease, which was undiagnosed before surgery. The follow-up period was 5 years. The possibilities and limitations of multiple methods of corneal melting treatment at the stages of persistent epithelial defect and corneal ulcer are discussed. The mechanism of disease development and its link with the pathogenesis of dry eye disease and the role of topical NSAIDs as a trigger for the initiation and progression of corneal melting are considered.

Objective: To describe a protocol for corneal ulcer monitoring utilizing daily fluorescein staining and evaluation of owner‐acquired anterior segment images. Animal studied: Nine client‐owned small animal patients (eight dogs, one cat) diagnosed with superficial corneal ulcers at the University of Georgia Veterinary Capitalize Hospital. Procedure(s): In addition to routine ulcer therapy, patients were discharged with supplies to perform daily fluorescein staining including a Quikvue® cobalt blue light camera adapter. Fluorescein staining was performed daily, photographs and/or videos were acquired at home by the patient's owner(s), and images were analyzed daily by trained personnel. In‐house examinations were performed weekly and within 24 h after the ulcer had appeared healed on photographs. Results: All (9/9) owners were able to take interpretable photographs. The majority (6/9) of patients had images successfully detailing their ulcer healing progress. One (1/9) patient appeared healed on images, but on subsequent examination had persistent ulceration covered by third eyelid elevation. Two (2/9) patients had persistent ulceration, consistent on both images and examination, but exited the study prematurely prior to ulcer healing. Conclusions: Remote fluorescein staining and image evaluation can be considered as an adjunct for monitoring ulcer healing but should not be used alone or as a substitute for ophthalmic examinations. Ulcers under the third eyelid have potential to be missed on image evaluation alone. [ABSTRACT FROM AUTHOR]

Simple Summary: Flat-faced (brachycephalic) dogs have increased in popularity despite growing awareness that extreme facial conformation with very bulging eyes compromises their health. Medial canthoplasty (MC) is a commonly performed surgical procedure in flat-faced dogs to improve their facial anatomy with the aim of decreasing eye irritation and discharge and reducing the likelihood of painful ulceration on the surface of the eye (cornea). This study analysed data from flat-faced dogs that were recommended and/or underwent MC. In addition, a questionnaire of owners' perceptions, including eye problems before and after the surgery, and overall satisfaction were collected. Nearly three-quarters of the dogs recommended surgery had a history of, or actively had, corneal ulceration. Under half of the dogs recommended MC went on to have surgery and three quarters of these were Pugs. MC significantly reduced eye discharge, frequency of owners cleaning around their dog's eyes, eye irritation and corneal ulceration with minimal complications and high owner satisfaction. These results demonstrate the value of MC surgery to improve the quality of life of flat-faced animals. Brachycephalic breeds have increased in popularity despite growing awareness of their predisposition to a wide range of conformation-related diseases. The extreme facial conformation of many popular brachycephalic breeds compromises their ocular surface health, increasing the risk of painful corneal ulceration. Medial canthoplasty (MC) is a surgical procedure to address ocular abnormalities in brachycephalic dogs, which are collectively referred to as brachycephalic ocular syndrome (BOS). This study retrospectively reviewed the records of dogs recommended MC at a referral hospital between 2016 and 2021. A questionnaire was designed to identify owners' perceptions pre- and post-operatively. From 271 brachycephalic dogs recommended MC, 43.5% (118/271) underwent surgery and 72.0% (85/118) were Pugs. The majority of dogs (73.7%, 87/118) that underwent surgery had current or historical corneal ulceration. Follow-up was available in 104 dogs, of which 5.7% (6/104) had corneal ulceration post-operatively. Sixty-four owners completed the questionnaire and reported post-operative corneal ulceration in 12.5% of dogs (8/64), reduced ocular discharge (70.8%, 34/48), reduced ocular irritation (67.7%, 21/31) and less periocular cleaning (52.5%, 32/61). Owners were satisfied with the clinical (85.9%, 55/64) and cosmetic (87.5%, 56/64) outcome. In conclusion, MC has high clinical relevance for the surgical management of BOS, restoring functional conformation and improving the quality of life of affected dogs. [ABSTRACT FROM AUTHOR]

ObjectiveTo compare complication rates and visual outcomes following phacoemulsification in Pugs versus dogs of other breeds.Animals studiedThirty-two pure-bred Pugs (55 eyes) and 32 dogs of other breeds (56 eyes) undergoing phacoemulsification.ProceduresMulti-institutional retrospective medical record review of perioperative factors, postoperative complications, and visual outcomes. The reference population of dogs of varying breeds included surgical cases following each Pug case at the same institutions. Perioperative risk factors and postoperative complication rates were compared between the two populations.ResultsPigmentary keratitis and diabetes mellitus were the most common preoperative comorbidities, found in 75% (P

Case Presentation: A 38-year-old male presented to the emergency department with methamphetamine-induced agitation. Physical exam showed clouding of the left cornea, with gelatinous appearance and associated conjunctivitis, consistent with corneal melt, or keratolysis.Discussion: Keratolysis is dissolution of the corneal stroma that can lead to corneal ulceration and vision loss. Smoking stimulants has been shown to be associated with this pattern of ocular injury, although this is a relatively rare presentation. Acute keratolysis is a unique complication of methamphetamine preparation and ingestion via smoking that can lead to corneal ulceration and loss of vision.

A 6-year-old male leopard gecko (Eublepharis macularius) was presented with a 2-year history of recurrent dysecdysis involving the ocular surface of both eyes. Ophthalmic examination revealed ocular surface desiccation and multifocal superficial ulcerative keratitis with patchy remnants of retained shed. Other abnormalities included stomatitis and mandibular and maxillary osteomyelitis. Topical and systemic antibiotic therapy, oral vitamin A, and improved husbandry conditions resolved the stomatitis and osteomyelitis but did not improve the ocular surface. Corneal cytology collected with a cytobrush revealed branching hyphae and budding yeast consistent with fungal keratitis. Fungal culture grew Acremonium sp. and Trichosporon sp. The addition of topical antifungal therapy improved the ocular surface health, but the patient was euthanized 7 weeks after initial presentation for persistent vomiting and dyspnea. Necropsy was declined. This case describes the first case of fungal keratitis caused by Acremonium sp. and Trichosporon sp. in a reptile.

Tetracycline had proven to be effective in the management of the different types of corneal ulcers. It has antimicrobial activity as well as anti-collaginase effect. Therefore, the present study was conducted to investigate the effect of oxytetracycline 5% on the alkali burn corneal ulcer after its injection subconjunctivaly. Ten healthy New Zealand albino rabbits were divided into equal groups (control and treatment). They were examined carefully before induction of the ulcer using in 1% NaOH in the right eye. A 0.5 ml of oxytetracycline 5% was injected in the subconjunctival space weekly for 5 consecutive weeks. The eye was examined weekly clinically and by fluorescein staining dye just before the injection of oxytetracycline. At the end of the study, the rabbits were euthanized and the eyes were harvested for histological and electron microscopic examinations. The results revealed there were no significant variations between the control and treatment groups except for prevention of bacterial colonization on the ulcerated corneal surface in the oxytetacycline group. The conclusion of the present study was the subconjunctival injection of oxytetracycline was not efficient for management of alkali burn corneal ulcers, but it could be used as adjunctive treatment for control and prevention of bacterial growth on the ulcerated corneal surface. [ABSTRACT FROM AUTHOR]

PURPOSE: The objective of this study was to evaluate interleukin-6 (IL-6) tear concentration and clinical outcome in patients with moderate-to-severe bacterial corneal ulcers post autologous platelet-rich plasma (PRP) eye drop therapy. MATERIALS AND METHODS: This was a pre–post designed study involving 21 moderate-severe corneal ulcer patients who got autologous PRP eye drop. Subjects were got autologous PRP eye drop as adjuvant therapy. Patients with moderate-to-severe infectious bacterial corneal ulcers were included in this study. Tear sampling was performed before therapy using sterile Schirmer paper from conjunctival inferior fornix. PRP therapy was performed for 7 days. Data recording and tear sampling were then performed at day 0 (pre-PRP), day 7 (D+7), and day 14 (D+14) after PRP therapy. Data recording included presence of pericorneal injection, blepharospasm, size of corneal defects, and hypopyon. RESULTS: There was a decrease in IL-6 tear concentration by day 14 after PRP therapy (P < 0.001). IL-6 concentration at day 7 after therapy (7525.67 ± 7092 pg/mL) tended to be lower before therapy (10,599 ± 6158 pg/mL), but not statistically significant (P = 0.156). The size of corneal defects decreased significantly post PRP at day 7 (P = 0.035) and at day 14 (P = 0.001). There was a significant blepharospasm at day 7 (P = 0.012) and day 14 (P < 0.001). There was a significant pericorneal injection only at day 14 (P = 0.002). There was no significant decreased hypopyon. CONCLUSION: There was a significant reduction in IL-6 tear concentration and clinical improvement in moderate-to-severe bacterial corneal ulcers which got autologous PRP eye drop as adjuvant therapy.

Background: Immunotherapy has been widely used to treat Colorectal cancer but has also observe some immune-related adverse effects. With proper treatment, most irAE can be solved and the effect of immunotherapy will not be affected by temporary immunosuppression. However, there are few reports about corneal irAE, and the current understanding of irAE is incomplete. Here we report a metastatic colorectal cancer case of immunerelated keratitis caused by nivolumab and to explore the occurrence of immune-related keratitis. Case description: Here we report the case of a 49-year-old man with mCRC who had no previous ocular disease but developed immune-related ulcerative keratitis after treatment with nivolumab. We summarize a large amount of literature to discuss the mechanism of immune-related keratitis. In addition, we conclude a method that may be used to detect the occurrence of immune keratitis, by monitoring MMPs and maspin in patients treated with nivolumab. We believe immune-related keratitis may be a rare complication of nivolumab in the treatment of mCRC. The effect of simple anti-infective therapy and repair-promoting drugs was not obvious, but the effect of glucocorticoid combined with autologous serum was significant. Conclusion: The mechanism of immune-related keratitis is that nivolumab destroys the immune microenvironment and ACAID, and affects corneal healing. Patients who use nivolumab can prevent immune keratitis by testing MMPs and maspin. The occurrence of immune keratitis may be a good indicator of the efficacy of ICI, and further study can be done in the follow-up. [ABSTRACT FROM AUTHOR]

Objective: To describe the clinical outcomes and efficacy of diamond burr debridement (DBD) treatment for corneal ulceration in cats. Procedure(s): Medical records of cats that received DBD at two private practices between 2015 and 2021 were retrospectively reviewed. DBD was performed using a battery‐powered, handheld motorized burr and a bandage contact lens was placed in 18/21 eyes. Corneal ulceration was considered resolved if the cornea was fluorescein negative with a stable epithelial surface. Recurrence was defined as return of corneal ulceration. Descriptive statistics and a Fisher's exact test were conducted on the study population. Results: Twenty‐one eyes from 20 cats with superficial corneal ulcers refractory to medical treatment underwent DBD. Domestic and Burmese were the most commonly encountered breeds and the median age of affected cats was 8.83 years (range 0.5–20 years). Corneal ulceration was present for a median of 14 days prior to DBD. Healing was achieved in 81% of eyes; with four eyes failing to heal and requiring further intervention. Corneal sequestrum was reported in one case that failed to heal. Of the healed cases, three cases recurred (17.6%) at a mean of 116.3 days (range 79–135 days). Burmese were overrepresented (p <.001) in cases that failed to heal or recurred (6/7 eyes; 85.7%). The median postoperative follow‐up time was 93 days (range 6–1613 days). Conclusions: Diamond burr debridement is a safe, non‐invasive treatment for corneal ulceration in cats but, compared with published results, it had a lower success rate than superficial lamellar keratectomy. [ABSTRACT FROM AUTHOR]

PURPOSE: The objective of this study was to evaluate interleukin-6 (IL-6) tear concentration and clinical outcome in patients with moderate-to-severe bacterial corneal ulcers post autologous platelet-rich plasma (PRP) eye drop therapy. MATERIALS AND METHODS: This was a pre-post designed study involving 21 moderate-severe corneal ulcer patients who got autologous PRP eye drop. Subjects were got autologous PRP eye drop as adjuvant therapy. Patients with moderate-to-severe infectious bacterial corneal ulcers were included in this study. Tear sampling was performed before therapy using sterile Schirmer paper from conjunctival inferior fornix. PRP therapy was performed for 7 days. Data recording and tear sampling were then performed at day 0 (pre-PRP), day 7 (D+7), and day 14 (D+14) after PRP therapy. Data recording included presence of pericorneal injection, blepharospasm, size of corneal defects, and hypopyon. RESULTS: There was a decrease in IL-6 tear concentration by day 14 after PRP therapy (P < 0.001). IL-6 concentration at day 7 after therapy (7525.67 ± 7092 pg/mL) tended to be lower before therapy (10,599 ± 6158 pg/mL), but not statistically significant (P = 0.156). The size of corneal defects decreased significantly post PRP at day 7 (P = 0.035) and at day 14 (P = 0.001). There was a significant blepharospasm at day 7 (P = 0.012) and day 14 (P < 0.001). There was a significant pericorneal injection only at day 14 (P = 0.002). There was no significant decreased hypopyon. CONCLUSION: There was a significant reduction in IL-6 tear concentration and clinical improvement in moderate-to-severe bacterial corneal ulcers which got autologous PRP eye drop as adjuvant therapy. [ABSTRACT FROM AUTHOR]

Corneal perforation is a rare and serious complication of ocular graft-versushost disease (oGVHD) patients. This study was to retrospectively report seven corneal perforation patients after allogeneic hematopoietic stem cell transplantation (HSCT). Demographic, hematologic, and ophthalmological data of patients were clarified in detail. Nine eyes of seven corneal perforation patients were clarified (Cases 3 and 6 were bilateral and the others are unilateral). All the cases had other affected GVHD organs, especially skin involvement. The duration between HSCT and corneal perforation was usually long with 21 (17-145) months as median interval, whereas the duration between oGVHD diagnosis and corneal perforation was relatively shorter with 4 (2-81) months as median interval. Most patients presented to ophthalmology department with poor visual acuity, BUT and Schirmer's test. Eyelid marginal hyperemia and irregularity were observed in most corneal perforation eyes. Keratoplasty or conjunctival flap covering (CFC) surgeries was performed after corneal perforation. After a long-term follow-up for most patients (median 21 months, range: 2-86 months), only two eyes of two patients (22.22%) had a final BCVA of 20/100 or better. Patients involved in both cutaneous GVHD and blepharitis indicate the aggressive development of oGVHD. Early diagnosis, long-term follow-up, and effective multi-disciplinary treatments for oGVHD patients are essential. Corticosteroids and immunosuppressor remain essential, whereas the use of topical corticosteroids should be carefully considered in corneal ulceration patients. In addition, appropriate surgeries should be performed to control oGVHD development in time. [ABSTRACT FROM AUTHOR]

ObjectiveCompare characteristics and clinical outcomes of dogs with infectious keratitis from Staphylococcus pseudintermedius considered to be multidrug-resistant (MDR) or not.ProceduresStaphylococcus pseudintermedius isolated as the primary pathogen from canine patients with ulcerative keratitis were considered MDR if resistant to at least one agent in three or more classes of antibiotics. Medical records were reviewed for history, patients' characteristics, clinical appearance, therapeutic interventions, and clinical outcomes.ResultsTwenty-eight dogs (28 eyes) were included. Compared to non-MDR cases, MDR diagnosis was significantly more common in dogs with recent (≤30 days) anesthesia (7/15 vs. 1/13, P = 0.038) and more common in non-brachycephalic dogs (8/15 vs. 2/13, P = 0.055). Clinical appearance (ulcer size/depth, anterior chamber reaction, etc.) did not differ significantly between groups (P ≥ 0.055). Median (range) time to re-epithelialization was longer in MDR vs. non-MDR eyes [29 (10–47) vs. 22 (7–42) days] but the difference was not significant (P = 0.301). Follow-up time was significantly longer in dogs with MDR keratitis [47 (29–590) vs. 29 (13–148) days, P = 0.009]. No other significant differences were noted between MDR and non-MDR eyes in regard to time for ulcer stabilization [4 (1–17) days vs. 4 (1–12), P = 0.699], number of eyes requiring surgical stabilization (7/15 vs. 7/13, P = 0.246) or enucleation (1/15 vs. 2/13, P = 1.000), success in maintaining globe (14/15 vs. 11/13, P = 0.583) or success in maintaining vision (12/15 vs. 10/13, P = 1.000).ConclusionsMDR infections may prolong corneal healing time but did not appear to affect overall clinical outcomes in dogs with bacterial keratitis. Further research is warranted in a larger canine population and other bacterial species.

Brachycephalic breeds have increased in popularity despite growing awareness of their predisposition to a wide range of conformation-related diseases. The extreme facial conformation of many popular brachycephalic breeds compromises their ocular surface health, increasing the risk of painful corneal ulceration. Medial canthoplasty (MC) is a surgical procedure to address ocular abnormalities in brachycephalic dogs, which are collectively referred to as brachycephalic ocular syndrome (BOS). This study retrospectively reviewed the records of dogs recommended MC at a referral hospital between 2016 and 2021. A questionnaire was designed to identify owners’ perceptions pre- and post-operatively. From 271 brachycephalic dogs recommended MC, 43.5% (118/271) underwent surgery and 72.0% (85/118) were Pugs. The majority of dogs (73.7%, 87/118) that underwent surgery had current or historical corneal ulceration. Follow-up was available in 104 dogs, of which 5.7% (6/104) had corneal ulceration post-operatively. Sixty-four owners completed the questionnaire and reported post-operative corneal ulceration in 12.5% of dogs (8/64), reduced ocular discharge (70.8%, 34/48), reduced ocular irritation (67.7%, 21/31) and less periocular cleaning (52.5%, 32/61). Owners were satisfied with the clinical (85.9%, 55/64) and cosmetic (87.5%, 56/64) outcome. In conclusion, MC has high clinical relevance for the surgical management of BOS, restoring functional conformation and improving the quality of life of affected dogs.

The red eye is a common presenting complaint among patients. Although assessment may seem intimidating, clinicians who are mindful of the patient's anticipated history and physical examination findings should be able to accurately diagnose and manage common conditions, identify ocular emergencies, and expedite care. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the outcomes of canine patients diagnosed with corneal ulceration associated with presumed calcareous corneal degeneration (CCD) that were treated with diamond burr keratotomy (DBK) and ongoing postoperative topical 3% or 4% Ethylenediaminetetraacetic acid (EDTA). Procedures: Retrospective assessment of CCD cases treated with ongoing topical EDTA following DBK between 2011 and 2020 at Veterinary Ophthalmic Referrals. Descriptive statistics of the study population were assessed, and a survival analysis was performed using R statistical software. Results: A total of 51 eyes from 41 dogs were assessed, with small terrier breeds overrepresented (27/41, 65.9%). Median age of dogs at the time of diagnosis was 14.3 years (range 8–17.2 years). Following DBK, the median time to commencement of topical EDTA was 11 days (range 0–28 days). Cases were followed for a median duration of 216 days (range 42–1379 days). Corneal ulceration recurred in 7/51 (13.7%) eyes at a median duration of 80 days (range 63–156 days). The probability of recurrence of corneal ulceration associated with CCD at 12 months was 15.6% (95% CI: 4.1–25.7%). A second DBK procedure followed by ongoing topical EDTA was performed in 4/7 (57.1%) of the recurred eyes. These retreated eyes had no further recurrence recorded and a median follow‐up time of 401 days (range 120–858 days). Conclusion: Ongoing topical EDTA following DBK is an effective adjunct treatment method for CCD with reduced rates of recurrence of CCD‐associated corneal ulceration when compared to published rates of recurrence when treated with DBK alone. [ABSTRACT FROM AUTHOR]

PurposeTo provide a perspective and surgical video demonstration of peripheral corneal ulceration and perforation managed with multilayered amniotic membrane transplantation.Case ReportsCase 1 describes a 48-year-old female with progressive redness and pain, and an inferonasal corneal thinning and perforation in the left eye from peripheral ulcerative keratitis. She underwent conjunctival recession with amniotic membrane inlay and onlay (Sandwich technique) transplantation. The amniotic membrane integrated well, and her Snellen visual acuity improved from 6/21 preoperatively to 6/9 at 3 months post op. Case 2 describes a 78-year-old male with redness and pain with temporal corneal thinning bilaterally and perforation in the right eye from peripheral ulcerative keratitis. Both eyes underwent similar surgical intervention with smooth integration of the amniotic membrane in the cornea and improvement in the visual acuity. Both patients were also started on systemic immunosuppression in collaboration with the rheumatology team.ConclusionWe report successful use of multilayered amniotic membrane transplantation for the treatment of corneal ulceration and perforation. The authors believe the simplicity of the surgical technique, easier access to amniotic membrane tissue, and lower induced post-operative astigmatism all provide advantages over alternative treatment modalities.

Purpose: 1% topical 5-fluorouracil (5-FU) is a treatment for ocular surface squamous neoplasia (OSSN) due to its effectiveness, low cost, and tolerable side effect profile. To our knowledge there is no reported sight-threatening corneal complication of 1% 5-FU for the treatment of OSSN. Observations: We report a 78 year-old man with bilateral conjunctival intraepithelial neoplasia (CIN) who developed bilateral corneoscleral ulceration and corneal perforation of the left eye after 1% 5-FU topical treatment. Conclusions and Importance: Our case report describes serious potential complications of 1% 5-FU, reviews possible risk factors associated with poor outcomes, and discusses our treatment approach.

Green nail syndrome (GNS) is a pseudomonal nail infection that presents with characteristic green nail discoloration. It typically affects patients with preexisting nail conditions or chronic exposure to wet environments but can also be seen with local trauma. Our patient presented with a pseudomonal corneal ulcer of the left eye and was incidentally found to have GNS, which developed after home artificial nail application. This unusual case of extensive pediatric GNS illustrates a rare and serious infectious complication of prolonged artificial nails. [ABSTRACT FROM AUTHOR]

Terrien marginal degeneration and Fuchs’ superficial marginal keratitis are considered rare and slowly progressive corneal diseases with a bilateral lesion, unknown etiology, and have a number of similar clinical signs. Clinically, Terrien marginal degeneration is characterized by peripheral thinning, which appears at the beginning of the disease usually in the upper half, but can also begin with the lower half of the cornea. In the case of Fuchs’ superficial marginal keratitis, biomicroscopic examination, at the initial stages of the disease’s development, in the lower and lower nasal segments, reveals peripheral corneal thinning. As a rule, in both diseases, the lesions on the two eyes are asymmetric, but peripheral corneal thinning is the main pathological sign. Purpose. To determine the diagnostic criteria for Terrien disease and Fuchs’ marginal keratitis, to identify their similarities and differences. Patients and methods. For the period 2017–2020, 40 patients were examined; they were divided into 3 groups. 30 patients with Terrien marginal degeneration, 7 patients with Fuchs’ superficial marginal keratitis, 3 patients with signs of Terrien marginal degeneration in one eye and typical manifestations of Fuchs’ superficial marginal keratitis in the other eye. The following methods were used for diagnostics: confocal microscopy, optical coherence tomography of the anterior segment, keratotopography. Results. A survey of 40 patients revealed many common clinical signs of two previously considered separate diseases. According to the literature, it is known that the main difference between these two diseases is the localization of corneal lesions. We found that different localization of the lesion in Terrien degeneration and superficial marginal Fuchs keratitis is present in some patients and only in the initial stages of both diseases. Conclusions. Terrien’s degeneration and Fuchs’ superficial marginal keratitis may be different variants of clinical manifestations or different stages of progression of the same disease. Since the etiology of Terrien’s degeneration and Fuchs’ superficial marginal keratitis had not been established, it is recommended to follow the clinical course of the diseases during treatment.

Background: The most common ocular disease affecting cattle worldwide is infectious bovine keratoconjunctivitis (IBK), which has been associated with Moraxella bovis bacterium. Objective: To report the molecular characterization of the ocular bacterial microbiota and its relation to IBK in cattle in two dairy regions in Michoacán, Mexico. Methods: A total population of 761 bovines were evaluated, of which 17 (2.23%) showed symptoms of IBK. Thirty-eight bacterial isolates from ocular samples of bovines with IBK were characterized by Gram-staining and antimicrobial sensitivity. In addition, isolates were identified by sequence comparisons of the 16S ribosomal gene. Results: The genus Moraxella was one of the most abundant bacteria and M. bovoculi was the most predominant species. Conclusion: The bacterial isolates identified in eye lesions of cattle and associated to IBK are diverse. To the author´s knowledge, this is the first study on the subject in Mexico; therefore, more research is needed to estimate the incidence of IBK and determine its associated microbiota.

Keywords: dupilumab; conjunctivitis; atopic dermatitis; corneal ulceration EN dupilumab conjunctivitis atopic dermatitis corneal ulceration e370 e372 3 09/15/22 20221001 NES 221001 Dear Editor, Ocular surface disease and worsening of preexisting conjunctivitis are well-known side effects of the treatment of an atopic patient with dupilumab. In particular, Li et al. described a patient who developed an inflammatory corneal ulcer on the right eye 3 weeks after starting bi-weekly intravenous dupilumab therapy. [Extracted from the article]

PurposeTo perform a Bayesian analysis of the Mycotic Ulcer Treatment Trial I (MUTT I) using expert opinion as a prior belief.MethodsMUTT I was a randomized clinical trial comparing topical natamycin or voriconazole for treating filamentous fungal keratitis. A questionnaire elicited expert opinion on the best treatment of fungal keratitis before MUTT I results were available. A Bayesian analysis was performed using the questionnaire data as a prior belief and the MUTT I primary outcome (3-month visual acuity) by frequentist analysis as a likelihood.ResultsCorneal experts had a 41.1% prior belief that natamycin improved 3-month visual acuity compared with voriconazole. The Bayesian analysis found a 98.4% belief for natamycin treatment compared with voriconazole treatment for filamentous cases as a group (mean improvement 1.1 Snellen lines, 95% credible interval 0.1-2.1). The Bayesian analysis estimated a smaller treatment effect than the MUTT I frequentist analysis result of 1.8-line improvement with natamycin versus voriconazole (95% confidence interval 0.5-3.0, P = 0.006). For Fusarium cases, the posterior demonstrated a 99.7% belief for natamycin treatment, whereas non-Fusarium cases had a 57.3% belief.ConclusionsThe Bayesian analysis suggests that natamycin is superior to voriconazole when filamentous cases are analyzed as a group. Subgroup analysis of Fusarium cases found improvement with natamycin compared with voriconazole, whereas there was almost no difference between treatments for non-Fusarium cases. These results were consistent with, though smaller in effect size than, the MUTT I primary outcome by frequentist analysis. The accordance between analyses further validates the trial results. (ClinicalTrials.gov number, NCT00996736.).

The most common ocular disease affecting cattle worldwide is infectious bovine keratoconjunctivitis (IBK), which has been associated with Moraxella bovis bacterium. Objective: To report the molecular characterization of the ocular bacterial microbiota and its relation to IBK in cattle in two dairy regions in Michoacán, Mexico. Methods: A total population of 761 bovines were evaluated, of which 17 (2.23%) showed symptoms of IBK. Thirty-eight bacterial isolates from ocular samples of bovines with IBK were characterized by Gram-staining and antimicrobial sensitivity. In addition, isolates were identified by sequence comparisons of the 16S ribosomal gene. Results: The genus Moraxella was one of the most abundant bacteria and M. bovoculi was the most predominant species. Conclusion: The bacterial isolates identified in eye lesions of cattle and associated to IBK are diverse. To the author's knowledge, this is the first study on the subject in Mexico; therefore, more research is needed to estimate the incidence of IBK and determine its associated microbiota. [ABSTRACT FROM AUTHOR]

Summary: Equine ulcerative keratomycosis is relatively commonly presented to teaching hospitals in North America, with a prevalence from 24 to 86%. Horses in Colorado may have lower risk due to the dry mountain climate, but data are lacking. This study aimed to determine the prevalence of ulcerative keratomycosis amongst horses with ulcerative keratitis presented to Colorado State University Veterinary Teaching Hospital (CSU‐VTH) ophthalmology service and to evaluate environmental factors (season, temperature, humidity, wind speed and elevation) associated with ulcerative keratomycosis in Colorado. A database search identified horses with ulcerative keratitis presented to the ophthalmology service at CSU‐VTH from January 2002 to August 2017. Sixty‐one horses met the inclusion criteria of a corneal cytology and/or culture or histopathology at the time of diagnosis; cases lacking that were excluded. Environmental factors at the boarding sites, including season, temperature, humidity, wind speed and elevation and clinical outcomes for fungal cases, were recorded. Prevalence of fungal infection amongst equine ulcerative keratitis was 16.4% (10/61), suggesting that CSU‐VTH has considerably fewer ulcerative keratomycosis cases than other veterinary teaching hospitals in North America. Spring (50%, 5/10) and fall (40%, 4/10) had the highest prevalence of fungal ulcerative keratitis in Colorado. Only one case was reported in summer (10%, 1/10); no horses were positive (0%, 0/10) in winter. Only wind speed seemed to influence the development of ulcerative keratomycosis with higher wind speeds associated with greater rates of fungal involvement (P = 0.047). Other environmental factors did not show a detectable association (all P‐values >0.05). Outcomes were variable. It was concluded that horses from the area of CSU‐VTH appear to be at lower risk for ulcerative keratomycosis than from the areas around other North American veterinary teaching hospitals that have reported data. Most horses with keratomycosis in this area present in the spring and fall. [ABSTRACT FROM AUTHOR]

Introduction: Canine bacterial keratitis is a corneal infection that causes various symptoms, including visual impairment, and necessitates eye removal in severe cases. Staphylococcus pseudintermedius is a pathogen that causes significant bacterial keratitis in canine patients. Moreover, multi-drug resistant Staphylococcus pseudintermedius (MDRSP) has been reported in both humans and animals. Regarding treatment failure against multi-drug resistant (MDR) pathogens with classic antibiotics, antimicrobial compounds derived from probiotics have been suggested as an alternative approach., Methods: Ligilactobacillus animalis SWLA-1 strain and its cell-free supernatant (CFS) have previously demonstrated potent antimicrobial activity against various MDR pathogenic bacteria. Based on this finding, we evaluated the anti-staphylococcal activity of CFS derived from Ligilactobacillus animalis SWLA-1 against MDRSP in a newly established ex vivo canine corneal infection model using fresh canine corneoscleral rims. Additionally, an in vitro cytotoxicity test using human keratocytes was performed., Results and Discussion: CFS significantly inhibited the growth of MDRSP in the novel ex vivo model and did not exhibit any significant toxicity against keratocytes in vitro. Based on these results, the antimicrobial compounds in CFS show potential as a novel approach for MDR staphylococcal keratitis treatment., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Jang, Lee, Kim, Lee and Kim.)

Purpose: To describe a case of corneal ulceration associated with dupilumab use for atopic dermatitis. Observations: A patient developed an inflammatory corneal ulcer 3 weeks after starting bi-weekly intravenous dupilumab therapy. Symptoms resolved with topical prednisolone and discontinuation of the systemic therapy with dupilumab. Conclusion and importance: Dupilumab is known to cause ocular surface inflammation, but we report a novel association between dupilumab use and potentially sight-threatening corneal ulceration.

Background: The congenital tarsal kink syndrome is a rare form of congenital upper eyelid entropion associated with cardiovascular, musculoskeletal or central nervous system disorders. This syndrome must be recognized and surgically treated as a perinatal emergency to avoid associated complications—corneal ulcer, corneal leucoma, secondary amblyopia and decreased vision among children. Methods: A literature review was conducted to clarify the diagnosis particularities and the corrective surgery options of the congenital entropion on the upper eyelid. Results: Four relevant studies were found by researching the Web of Science and PubMed databases up to November 2021 for “congenital tarsal kink syndrome” and “congenital upper eyelid entropion”. Conclusions: In this paper, we present a case of congenital unilateral entropion of the upper left eyelid in the context of a tarsal kink syndrome in a one-month old infant, manifested by the absence of eyelashes on the upper eyelid of the left eye, hyperlacrimation and conjunctival hyperemia. Essential in managing the upper eyelid entropion is protecting the cornea. Furthermore, correcting a tarsal kink is eminently surgical, choosing between open or closed procedures. Herein, we address the difficulty in the timely diagnosis of this uncommon condition and make formal recommendations based on all reported cases.

Allergic contact dermatitis, case report, corneal ulceration, cytotoxicity, dicyclohexylcarbodiimide, exposure, irritant contact dermatitis, occupational contact dermatitis, safety training, CAS 538-75-0, irritant conjunctivitis Keywords: allergic contact dermatitis; CAS 538-75-0; case report; corneal ulceration; cytotoxicity; dicyclohexylcarbodiimide; exposure; irritant conjunctivitis; irritant contact dermatitis; occupational contact dermatitis; safety training EN allergic contact dermatitis CAS 538-75-0 case report corneal ulceration cytotoxicity dicyclohexylcarbodiimide exposure irritant conjunctivitis irritant contact dermatitis occupational contact dermatitis safety training 48 50 3 12/17/21 20220101 NES 220101 Dicyclohexylcarbodiimide (DCC; CAS no. 538-75-0) has been used by the pharmaceutical industry as a coupling agent in polypeptide synthesis.1 It is a versatile organic reagent that has increased use in the elastomers, fibres, foam, and polyester industries, as well as the recombinant DNA industry and food industry.2,3 Reports have shown that DCC is a known elicitor of irritant and/or allergic contact dermatitis; however, its potentially acute cytotoxic effects may be underappreciated.4,5 A Material Safety Data Sheet for DCC not only states that it can cause skin sensitization, but also demonstrates that it can lead to acute dermal toxicity, serious eye damage, and acute oral toxicity.6 We describe a case of exposure to DCC with complications extending beyond the severity of just cutaneous dermatitis. [Extracted from the article]

Purpose: To describe ocular clinical findings, gross/histopathologic findings, and treatment regimens in a series of migratory chuck-will's-widows (Antrostomus carolinensis) (CWW) with corneal epithelial defects. Methods: Seven CWW were presented to the South Florida Wildlife Center (SFWC). Four presented with bilateral (OU) corneal ulceration; two developed corneal ulceration OU; one had no ocular lesions. Treatment protocols for patients with corneal ulcers included the following: medical therapy only or medical therapy combined with an additional procedure. Four patients including the bird with no ocular lesions were euthanized, and one patient died. Their globes were submitted for histopathology. Two patients were released. Results: Clinical findings prior to enucleation included superficial corneal ulceration with redundant epithelium persisting weeks to >1 month. On histopathology, epithelium in nonulcerated globes was remarkably thin; this was considered normal. Common histopathologic findings of ulcerated globes revealed epithelial and conjunctival attenuation with an acellular superficial stromal layer and hypercellular mid-stromal layer. One globe healed with medical therapy and cotton tip applicator debridement. Four globes healed by combination of medical therapy, equine amnion, nictitating membrane (NM) flap, and temporary tarsorrhaphy. No globes healed with diamond burr debridement or grid keratotomy. Conclusions: Factors that may be contributing to these corneal epithelial defects include, but are not limited to, normally thin epithelium, exposure keratopathy, neurotrophic disease, epithelial turnover and inadequate stem cell recruitment, inherited/genetic causes, and unidentified infectious agents (eg, viral etiologies). Of the 12 eyes treated, one healed with medical therapy/cotton tip applicator debridement, and four healed with medical therapy/equine amnion/nictitating membrane flap/temporary tarsorrhaphy. [ABSTRACT FROM AUTHOR]

Abstract Background Corneal ulcerative disease (CUD) has the potential to adversely affect animal welfare by interfering with vision and causing pain. The study aimed to investigate for the first time the prevalence, breed-based risk factors and clinical management of CUD in the general population of dogs under primary veterinary care in England. Results Of 104,233 dogs attending 110 clinics participating within the VetCompass Programme from January 1st to December 31st 2013, there were 834 confirmed CUD cases (prevalence: 0.80%, 95% confidence interval (CI) 0.75–0.86). Breeds with the highest prevalence included Pug (5.42% of the breed affected), Boxer (4.98%), Shih Tzu (3.45%), Cavalier King Charles Spaniel (2.49%) and Bulldog (2.41%). Purebred dogs had 2.23 times the odds (95% CI 1.84–2.87, P

Objective: Compare CXL treatment with medical treatment alone in horses with stromal, ulcerative keratitis. Animals studied: 24 horses (24 eyes) with stromal, ulcerative keratitis were included. Procedure: 12 horses were initially treated with CXL, and 12 horses were given conventional medical treatment. Topical medical treatment was added to horses in the CXL group if necessary. Parameters including cytology, microbial growth, time to fluorescein negativity, and time to inhibition of stromal melting were evaluated. Results: After the first day of treatments, a decrease in inflammatory signs and pain from the eye was observed in both groups. Stromal melting ceased within 24 hours regardless of treatment. CXL treatment alone was sufficient in 3 horses with noninfectious, superficial stromal ulcerations. Clinical signs of impaired wound healing were seen after 3‐14 days in corneas with suspected or proven bacterial infection treated with CXL only, most likely because of insufficient elimination of bacteria deeper in the corneal stroma or because of re‐infection from bacteria in the conjunctiva. The average decrease in stromal ulcer area per day after onset of treatment was almost identical between the groups, and no significant difference in time to fluorescein negativity was found. Conclusions: We consider CXL a possible useful adjunct treatment of corneal stromal ulcers in horses, especially for melting ulcers and as a potential alternative to prophylactic antibiotic treatment for noninfected stromal ulcers. However, CXL should not be used alone for infected or suspected infected stromal ulcers, because topical antibiotics were required in all horses with proven infectious keratitis. [ABSTRACT FROM AUTHOR]

Summary: This case series addresses a clinical approach to a specific type of infected corneal ulceration in horses; the slow‐healing superficial complicated corneal ulceration involving a fastidious or possibly newly identified bacteria for which no antibiotic sensitivity can be determined. These corneal ulcerations present as superficial, nonhealing lesions that appear infected based on cellular infiltration of the cornea. Because they are superficial, they do not appear to be as serious to the referral veterinarian as deep stromal corneal ulcerations. However, superficial corneal ulcerations are complicated and slow healing, ultimately frustrating both owners and primary care clinicians. Culture results are often negative, or implicate a newly identified bacteria with no known antimicrobial sensitivity in horses. [ABSTRACT FROM AUTHOR]

Purpose: To present anterior segment ophthalmic manifestations of Wiskott–Aldrich syndrome (WAS), a rare X-linked primary immune-deficiency. Observations: A 15-year old male with WAS presented with multiple corneal ulcers of the left eye. Once resolved, this was followed by separate episodes of episcleritis in the left eye and corneal infiltrates of the right eye. Successful treatment included topical antibiotics and anti-inflammatories. Conclusions: Ocular manifestations of WAS, due to secondary infection and inflammation, may be severe. This case report emphasizes the importance of prompt ophthalmic evaluation and treatment of these patients.