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Background: Poor surgical outcomes remain a problem in trachoma-endemic countries working to reach elimination thresholds. Methods to improve outcomes could positively impact programmatic success. Methods: This parallel, three-armed clinical trial conducted in Ethiopia randomized individuals with previously unoperated trachomatous trichiasis (TT) to receive surgery utilizing one of three approaches: bilamellar tarsal rotation with a 3 mm incision height (BLTR-3), BLTR with 5 mm incision height (BLTR-5) and posterior lamellar tarsal rotation (PLTR). We followed participants for one year. The primary outcome was post-operative trichiasis (PTT). Secondary outcomes were eyelid contour abnormalities (ECA) and pyogenic granulomata. Findings: We randomized and operated on 4,914 individuals with previously unoperated TT (6,940 eyes). Primary analyses include 6,815 eyes with follow-up. Overall, 1,149 (16.9%) eyes developed PTT. The risk difference for PTT was minimal comparing BLTR-3 and PLTR (adjusted risk difference [aRD] 1.8% (98.3%CI: -0.5–4.2%)), but significantly higher for BLTR-5 surgeries compared to BLTR-3 (aRD: 6.7% (3.9–9.4%)) and PLTR (aRD: 8.6% (5.9–11.3%)). BLTR-5 had the lowest ECA (6.1% versus 9.6% BLTR-3, 11.2% PLTR) and granuloma rates (5.2% versus 6.5% BLTR-3 and 7.5% PLTR). One eyelid operated with PLTR experienced an eyelid margin division; four BLTR-3 and eight BLTR-5 eyelids experienced excessive bleeding. Interpretation: We do not recommend modifying the BLTR incision height of 3 mm. Overall, we did not find a significant difference in PTT between BLTR-3 and PLTR in terms of PTT or ECA. Trial registration: Registration number: NCT03100747; ClinicalTrials.gov Full study protocol available at (https://doi.org/10.15139/S3/QHZXWD) Author summary: Trachomatous trichiasis (TT) surgery is the primary way to manage in-turned eyelashes in trachoma-endemic settings. The goal of this study was to understand what procedure has the best outcomes. We compared three ways of doing TT surgery: bilamellar tarsal rotation (BLTR) surgery with the World Health Organization recommended 3 mm incision height, BLTR with the incision height increased to 5 mm and posterior lamellar tarsal rotation (PLTR). We hypothesized that increasing the BLTR incision height to 5 mm would reduce post-operative trichiasis (PTT) compared with the 3 mm height. On the contrary, this study demonstrates that increasing the incision height of BLTR surgeries does not improve PTT rates. It also suggests that BLTR and PLTR surgeries can have similar outcomes in some settings. Further research is needed to examine the impact of training order on surgery outcomes. The study also investigated whether surgeon performance on a particular procedure depends on the order they were trained. The current study does not suggest that converting BLTR to PLTR surgeons reduces PTT rates. However, given the small number of conversion surgeons in this study, further research is needed to evaluate whether retraining BLTR surgeons is warranted. [ABSTRACT FROM AUTHOR]

Ritlecitinib (Litfulo™) is a valuable new option for the treatment of severe alopecia areata in individuals aged ≥ 12 years. Of note, ritlecitinib, a dual selective Janus kinase (JAK)-3/TEC family kinase inhibitor, is the first targeted treatment for severe alopecia areata to be approved for use in adolescents. In the pivotal, randomised, double-blind, placebo-controlled, phase 2b/3 ALLEGRO trial in adults and adolescents with alopecia areata with ≥ 50% scalp hair loss, once-daily oral ritlecitinib 50 mg significantly increased the percentage of patients achieving ≤ 20% scalp hair loss at 24 weeks. Ritlecitinib therapy was also associated with eyebrow and eyelash regrowth. Response rates for key efficacy outcomes in the pivotal trial continued to increase with treatment up to 48 weeks. Longer-term data indicate that responses are sustained with continued treatment. Ritlecitinib is generally well tolerated, with most adverse events being of mild severity and not requiring dose interruption or treatment discontinuation. Plain Language Summary: Alopecia areata is an autoimmune disease characterised by hair loss, including from the scalp, face and/or body. It has a lifetime incidence of approximately 2% globally, affecting both children and adults, and can be associated with a significant psychological burden. For severe disease (generally defined as ≥ 50% scalp hair loss), there are few effective treatments available. Ritlecitinib (Litfulo™) is a valuable new treatment option, approved in the EU, the USA and several other countries for the treatment of severe alopecia areata in individuals aged ≥ 12 years, making it the first targeted treatment to be approved for use in adolescents. As demonstrated in the pivotal ALLEGRO-2b/3 clinical trial, ritlecitinib, taken orally (as a capsule) once daily, provides clinically meaningful hair regrowth (including eyebrow and eyelash regrowth) in patients with alopecia areata with ≥ 50% scalp hair loss. Furthermore, hair regrowth is sustained longer term with continued treatment. Ritlecitinib is generally well tolerated, with most adverse events being of mild severity. [ABSTRACT FROM AUTHOR]

Relatively more-apparent body parts are often used to name relatively less-apparent body parts. To explore this etymological phenomenon, this report assesses anatomical terminology derived from some of the most apparent structures of the human body—hairs. Hair-related anatomical terminology involves varied etymons, roots, and derivatives: calvus "bald," cilia "eyelashes," glaber "hairless," pilus "hair," pubes (historically referring to the developing beard), pudendum "modesty" (referring to hair growth that covers genitalia), tempus "time" (referring to the location where hair commonly grays, thus showing a person's age), and tragus "goat" (referring to the tuft of hair that resembles the beard of a goat). Also including lanugo, vibrissae, hirci, flocculus, and cauda equina, a systematic review of Terminologia Anatomica and Terminologia Neuroanatomica revealed 285 unique non-duplicate hair-related terms. Several anatomical terms allude to particular age groups or sexes, but are used indiscriminately (e.g., tragus alludes to the older male ear, though may describe the fetal female ear). Likewise, human-centric anatomical terminology influences non-human anatomical terminology— a turtle has a "temporal bone" only because some humans develop gray hair on the sides of their heads as they age. Accordingly, etymological recursion is common: The human ear has a tragus, named after the goat, and the goat ear has a tragus, named after the human tragus, that was named after the goat. The use of Latin as the foundation of anatomical and medical terminology may appear seriously supercilious; however, it is often simply super silly. After all, hundreds of body parts are formally named after hair. [ABSTRACT FROM AUTHOR]

The eyelid margin is vital to ocular surface integrity. Much peerreviewed literature has been established in eyelid margin inflammation, better known as blepharitis. The purpose was to review and understand the impact of eyelid margin disease. Anterior blepharitis causes inflammation at the eyelash base, ciliary follicles, and the palpebral skin. Posterior blepharitis occurs when there is inflammation with the posterior eyelid margin disease. In common usage, the term "blepharitis" used alone almost always refers to anterior blepharitis. Classification of eyelid margin disease should be based on etiopathogenesis, location, primary vs secondary, and chronicity. Blepharitis has several etiopathologies (infectious, inflammatory, and squamous). Meibomian gland dysfunction (MGD) can refer to the functional and/or structural problems with the meibomian gland. Meibomitis (or meibomianitis) occurs when there is inflammation associated with the MGD. The presence of blepharitis and/orMGD(with or without inflammation) can affect the ocular surface and thereby affect anterior segment and cataract surgeries. This review article evaluates the differential diagnoses of eyelid margin disease, including various forms of blepharitis, MGD, and meibomitis. [ABSTRACT FROM AUTHOR]

Surgical reconstruction of medially located lower eyelid defects can be challenging. The Hughes procedure, considered the standard for reconstruction in such cases, often falls short in terms of cosmetic outcomes. An alternative approach that combines medial transposition with a tarsal graft and periosteal strip has shown promise. Here, we aim to demonstrate the cosmetic advantages of medial transposition of a preserved temporal lower eyelid over other techniques. We conducted a retrospective study involving seven well-documented patients who underwent the procedure described below. The study was approved by the University's Ethics Committee. All patients were followed up for one year. Lower eyelid defects spanned 50–80% of their total length, situated in the central third of the eyelid or the central to medial portion. Postoperative complications were minimal, with all patients exhibiting good cosmetic, functional, and anatomical outcomes at follow-up. The absence of eyelashes is well tolerated if it is lateral, but when the defect is medial, medial transposition could be a good alternative to the familiar Hughes surgical intervention. [ABSTRACT FROM AUTHOR]

Addressing issues such as low localization accuracy, poor robustness, and long average localization time in pupil center localization algorithms, an improved YOLOv8 network-based pupil center localization algorithm is proposed. This algorithm incorporates a dual attention mechanism into the YOLOv8n backbone network, which simultaneously attends to global contextual information of input data while reducing dependence on specific regions. This improves the problem of difficult pupil localization detection due to occlusions such as eyelashes and eyelids, enhancing the model's robustness. Additionally, atrous convolutions are introduced in the encoding section, which reduce the network model while improving the model's detection speed. The use of the Focaler-IoU loss function, by focusing on different regression samples, can improve the performance of detectors in various detection tasks. The performance of the improved Yolov8n algorithm was 0.99971, 1, 0.99611, and 0.96495 in precision, recall, MAP50, and mAP50-95, respectively. Moreover, the improved YOLOv8n algorithm reduced the model parameters by 7.18% and the computational complexity by 10.06%, while enhancing the environmental anti-interference ability and robustness, and shortening the localization time, improving real-time detection. [ABSTRACT FROM AUTHOR]

Demodex blepharitis, a chronic lid margin disease, is caused by an infestation of Demodex mites, the most common ectoparasites in human skin and eyelids. Lotilaner ophthalmic solution, 0.25% (Xdemvy, Tarsus Pharmaceuticals), is the first therapy approved to treat Demodex blepharitis. This narrative review characterizes lotilaner ophthalmic solution, 0.25%, and describes its efficacy, safety, and tolerability. The safety and efficacy of lotilaner ophthalmic solution, 0.25%, for treating Demodex blepharitis was evaluated in four phase 2 and two phase 3 trials. The data of 980 patients included in these phase 2 and 3 clinical trials revealed that the proportion of eyes with a clinically meaningful reduction to 10 or fewer collarettes (the cylindrical, waxy debris found at the base of the eyelashes) ranged from 81 to 93%. The mite eradication rate confirmed by a microscopy of epilated lashes ranged from 52 to 78%. No serious treatment-related adverse events were reported in any of these clinical studies. As high as 92% of the patients receiving lotilaner eyedrops in the phase 3 trials found it to be neutral to very comfortable. Given the positive safety and efficacy outcomes, the drug is likely to become the standard of care in the treatment of Demodex blepharitis. [ABSTRACT FROM AUTHOR]

Background: Cognitive impairment in the elderly may lead to potential increased sensitivity to anesthetic agents targeting receptors associated with cognition. This study aimed to explore the effect of cognitive status on propofol consumption during surgery in elderly patients. Methods: Sixty elderly patients scheduled for laparoscopic radical prostatectomy were allocated to either a cognitively normal [CogN, Montreal Cognitive Assessment (MoCA) score ≥26] or cognitively impaired (CogI, MoCA <26) group. Propofol was administered via target-controlled infusion to maintain a bispectral index (BIS) between 55-65 during surgery. Propofol consumption was recorded at three time points: T1 (abolished eyelash reflex), T2 (BIS = 50), T3 (extubation). BIS values at eyelash reflex abolition were also recorded. Postoperative MoCA, Visual Analogue Scale (VAS) scores, and remifentanil/sufentanil consumption were assessed. Results: BIS values before induction were similar between CogN and CogI groups. However, at eyelash reflex abolition, BIS was significantly higher in CogI than CogN (mean ± SD: 65.3 ± 7.2 vs. 61.1 ± 6.8, p = 0.031). Propofol requirement to reach BIS 50 was lower in CogI vs. CogN (1.24 ± 0.19 mg/kg vs. 1.46 ± 0.12 mg/kg, p = 0.003). Postoperative MoCA, VAS scores, and remifentanil/sufentanil consumption did not differ significantly between groups. Conclusion: Compared to cognitively intact elderly, those with cognitive impairment exhibited higher BIS at eyelash reflex abolition and required lower propofol doses to achieve the same BIS level, suggesting increased propofol sensitivity. Cognitive status may impact anesthetic medication requirements in the elderly. [ABSTRACT FROM AUTHOR]

Vitiligo is a frequent acquired pigmentation disease which, although rarely, can be present at birth, as in the current case, observed by us at the age of 8 with stable vitiligo, white forelock and poliosis of the eyelashes. The case was presented to discuss the difficulties encountered in excluding various syndromic associations and management strategies. [ABSTRACT FROM AUTHOR]

Purpose: To study the demographic, clinical, and microbiological profile of Demodex‑related blepharokeratoconjunctivitis (BKC) at a tertiary eye care hospital. Methods: This retrospective observational study was conducted from January 2016 to September 2022. It included 83 patients with microbiologically proven Demodex BKC who presented to the cornea department of our tertiary care eye center. The clinical, microbiological, and demographic data of the 83 cases were analyzed. Results: Of the 83 cases, 57 (68.67%) were younger than 40 years, and 25 (30.12%) were below 20. Most patients presented with a good visual acuity of 20/40 or better (93 eyes; 84.55%). The disease was unilateral in 55 patients and bilateral in 28. Cylindrical dandruff was the predominant presentation noted in 61 eyes (54.95%), followed by corneal scarring in 47 eyes (42.34%) and corneal vascularization in 40 eyes (36.04%). On light microscopy, 87.95% of the positive samples were identified as Demodex folliculorum, 7.23% as Demodex brevis, and 6.02% remained unidentified. Tea tree oil and lid scrubs eradicated the disease in most patients clinically (75/83, 90.36%). Conclusion: The spectrum of BKC includes both lid signs and corneal involvement. It can be a cause of recurrent BKC and detection of the mite by microscopic evaluation of the lashes can confirm the diagnosis. In most cases, the tea tree oil can effectively manage this condition. However, low doses of topical steroids are needed to control the inflammation in patients with corneal involvement. [ABSTRACT FROM AUTHOR]

Background: Eyelash serums, both prescription and over‐the‐counter, are gaining popularity for enhancing the appearance of eyelashes through various biologically active molecules. Categorized into prostaglandin analogs and non‐prostaglandin analogs, these serums claim increased strength, length, luster, and thickness. Current United States law also requires no efficacy or safety assessments by the Food and Drug Administration before approving products for consumer use, potentially posing health risks for patients seeking over‐the‐counter eyelash enhancements. Aims: Our aims include exploring proposed benefits and adverse effects associated with eyelash serums, while providing evidence‐based clinical recommendations on their use. We aim to contribute valuable insights to the understanding of eyelash serums and their respective safety considerations. Methods: The authors conducted a comprehensive electronic search across databases including PubMed, Embase, Cochrane Central, and Google Scholar to evaluate eyelash serum ingredients. Articles were evaluated by two independent researchers for relevance, and the ingredients discussed were analyzed and given clinical recommendations for eyelash serums based off the Oxford Centre for Evidence‐Based Medicine. Results: Results highlight bimatoprost's efficacy, supported by numerous studies evaluating safety and adverse effects. Other prostaglandin ingredients show potential benefits, but further studies are encouraged to enhance the understanding of respective safety profiles. While non‐prostaglandins ingredients show promising data, more studies are needed due to a lack of formal evidence in eyelash serum use. Conclusion: As the cosmeceutical market for eyelash serums is growing, dermatologists need to be knowledgeable about evidence‐based information regarding prescription and over‐the‐counter eyelash serum products before making recommendations to patients. [ABSTRACT FROM AUTHOR]

Background: Eyelashes play a crucial role in self‐image and ocular protection. Enhancements to their structure are of both cosmetic and clinical interest. Aims: To assess the efficacy of a peptide and glycosaminoglycan‐based eyelash enhancer serum in improving eyelash structure. Patients/Methods: This open‐label clinical trial involved 30 females aged 25–65. Eyelashes were assessed at baseline (D0), 4 weeks (D28), and 12 weeks (D84) using specialized software and high‐resolution imagery. Measurements included lash number, width, length, volume, arc, and angle. Results: At 12 weeks, significant increases were observed in lash length (+8.3%), number (+5%), width (+10.1%), volume (+14.1%), arc (+13.4%), and angle (+28.3%) compared to baseline. Global Eyelash Assessment (GEA) scores significantly improved, and patient treatment satisfaction increased from 73.34% at D28 to 84.33% at D84. No adverse effects were reported. Conclusions: The eyelash growth enhancer serum demonstrated significant efficacy in improving eyelash structure by Week 12, with early signs of improvement evident by Week 4. The high patient satisfaction levels underscore the perceived effectiveness of the product. [ABSTRACT FROM AUTHOR]

Multi-modal ocular biometrics has recently garnered significant attention due to its potential in enhancing the security and reliability of biometric identification systems in non-constrained scenarios. However, accurately and efficiently segmenting multi-modal ocular traits (periocular, sclera, iris, and pupil) remains challenging due to noise interference or environmental changes, such as specular reflection, gaze deviation, blur, occlusions from eyelid/eyelash/glasses, and illumination/spectrum/sensor variations. To address these challenges, we propose OcularSeg, a densely connected encoder–decoder model incorporating eye shape prior. The model utilizes Efficientnetv2 as a lightweight backbone in the encoder for extracting multi-level visual features while minimizing network parameters. Moreover, we introduce the Expectation–Maximization attention (EMA) unit to progressively refine the model's attention and roughly aggregate features from each ocular modality. In the decoder, we design a bottom-up dense subtraction module (DSM) to amplify information disparity between encoder layers, facilitating the acquisition of high-level semantic detailed features at varying scales, thereby enhancing the precision of detailed ocular region prediction. Additionally, boundary- and semantic-guided eye shape priors are integrated as auxiliary supervision during training to optimize the position, shape, and internal topological structure of segmentation results. Due to the scarcity of datasets with multi-modal ocular segmentation annotations, we manually annotated three challenging eye datasets captured in near-infrared and visible light scenarios. Experimental results on newly annotated and existing datasets demonstrate that our model achieves state-of-the-art performance in intra- and cross-dataset scenarios while maintaining efficient execution. [ABSTRACT FROM AUTHOR]

Eye gaze and expressions are crucial non‐verbal signals in face‐to‐face communication. Visual effects and telepresence demand significant improvements in personalized tracking, animation, and synthesis of the eye region to achieve true immersion. Morphable face models, in combination with coordinate‐based neural volumetric representations, show promise in solving the difficult problem of reconstructing intricate geometry (eyelashes) and synthesizing photorealistic appearance variations (wrinkles and specularities) of eye performances. We propose a novel hybrid representation ‐ ShellNeRF ‐ that builds a discretized volume around a 3DMM face mesh using concentric surfaces to model the deformable 'periocular' region. We define a canonical space using the UV layout of the shells that constrains the space of dense correspondence search. Combined with an explicit eyeball mesh for modeling corneal light‐transport, our model allows for animatable photorealistic 3D synthesis of the whole eye region. Using multi‐view video input, we demonstrate significant improvements over state‐of‐the‐art in expression re‐enactment and transfer for high‐resolution close‐up views of the eye region. [ABSTRACT FROM AUTHOR]

High‐fidelity digital human modeling has become crucial in various applications, including gaming, visual effects and virtual reality. Despite the significant impact of eyelashes on facial aesthetics, their reconstruction and modeling have been largely unexplored. In this paper, we introduce the first data‐driven generative model of eyelashes based on semantic features. This model is derived from real data by introducing a new 3D eyelash reconstruction method based on multi‐view images. The reconstructed data is made available which constitutes the first dataset of 3D eyelashes ever published. Through an innovative extraction process, we determine the features of any set of eyelashes, and present detailed descriptive statistics of human eyelashes shapes. The proposed eyelashes model, which exclusively relies on semantic parameters, effectively captures the appearance of a set of eyelashes. Results show that the proposed model enables interactive, intuitive and realistic eyelashes modeling for non‐experts, enriching avatar creation and synthetic data generation pipelines. [ABSTRACT FROM AUTHOR]

Background: Bimatoprost has emerged as a significant medication in the field of medicine over the past several decades, with diverse applications in ophthalmology, dermatology, and beyond. Originally developed as an ocular hypotensive agent, it has proven highly effective in treating glaucoma and ocular hypertension. Its ability to reduce intraocular pressure has established it as a first-line treatment option, improving management and preventing vision loss. In dermatology, bimatoprost has shown promising results in the promotion of hair growth, particularly in the treatment of alopecia and hypotrichosis. Its mechanism of action, stimulating the hair cycle and prolonging the growth phase, has led to the development of bimatoprost-containing solutions for enhancing eyelash growth. Aim: The aim of our review is to provide a brief description, overview, and studies in the current literature regarding the versatile clinical use of bimatoprost in recent years. This can help clinicians determine the most suitable individualized therapy to meet the needs of each patient. Methods: Our methods involve a comprehensive review of the latest advancements reported in the literature in bimatoprost formulations, which range from traditional eye drops to sustained-release implants. These innovations offer extended drug delivery, enhance patient compliance, and minimize side effects. Results: The vast literature published on PubMed has confirmed the clinical usefulness of bimatoprost in lowering intraocular pressure and in managing patients with glaucoma. Numerous studies have shown promising results in dermatology and esthetics in promoting hair growth, particularly in treating alopecia and hypotrichosis. Its mechanism of action involves stimulating the hair cycle and prolonging the growth phase, leading to the development of solutions that enhance eyelash growth. The global use of bimatoprost has expanded significantly, with applications growing beyond its initial indications. Ongoing research is exploring its potential in glaucoma surgery, neuroprotection, and cosmetic procedures. Conclusions: Bimatoprost has shown immense potential for addressing a wide range of therapeutic needs through various formulations and advancements. Promising future perspectives include the exploration of novel delivery systems such as contact lenses and microneedles to further enhance drug efficacy and patient comfort. Ongoing research and future perspectives continue to shape its role in medicine, promising further advancements and improved patient outcomes. [ABSTRACT FROM AUTHOR]

The upper eyelid is a complex structural part of the face that plays an important role in protecting the cornea from drying and damage to preserve vision. The eyelashes are an essential part of the upper eyelid and help in protecting the eyes from dust, foreign bodies, and sweat. Being a part of the face, which is the most noticeable part of the body, both structures hold an important role in reconstructive procedures. Reconstruction of both structures simultaneously is tricky but helps reduce the number of procedures required in achieving an aesthetically acceptable eye. Our techniques describe the use of the paramedian forehead flap with an anterior hairline to reconstruct the upper eyelid and eyelashes in a single stage in a posttraumatic near-total upper eyelid defect with a favorable outcome. Depending on the parting of the patient's hair, the anterior hairline of one side can be included in the distal edge of the flap while raising, which can be inset so that the direction and orientation of the eyelashes perfectly match. Our technique refurbishes an established technique for eyelid reconstruction to include eyelash reconstruction at the same time, thus saving time and resources without any inconvenience to the patient. [ABSTRACT FROM AUTHOR]

Background: Demodex blepharitis (DB) is a common disease of the ocular surface. The characteristics of the bacterial community in eyelash roots after Demodex infestation are still unknown. Knowledge of the characteristics of the bacterial community of eyelash follicles in patients with DB can provide valuable insights for guiding the diagnosis and treatment of DB. Methods: Twenty-five patients with DB (DB group) and 21 non-DB volunteers (control group) were enrolled in the study. Eyelashes from the upper eyelid of the right eye were sampled, and 16S ribosomal DNA (rDNA) sequencing was performed to determine the V3-V4 regions of the microbial 16S rDNA gene within 1 month of infestation. The sequencing data of the two groups were analyzed and compared. The effect of the bacterium Burkholderia on the survival of Demodex mites was evaluated using Demodex obtained from 12 patients with DB other that the patients in the DB group. Results: A total of 31 phyla and 862 genera were identified in the DB and control groups. The five most abundant phyla in the two groups were Proteobacteria, Firmicutes, Actinobacteria, Bacteroidetes and Cyanobacteria. The abundance of Actinomycetes was significantly higher in the DB group than in the control group. At the genus level, the five most abundant genera in the two groups were Pseudomonas, Burkholderia-Caballeronia-Paraburkholderia, Rolstonia and Acinetobacter; Clostridium sensu stricto 1 was abundant in the control group and Corynebacterium_1 was abundant in the DB group. Compared with the control group, the abundance of Burkholderia-Caballeronia-Paraburkholderia was 2.36-fold lower in the DB group. Linear discriminant analysis Effect Size (LEfSe) analysis revealed Burkholderia-Caballeronia-Paraburkholderia, SC84_unclassified, Nonmyxobacteria and Succinvibrio to be the major biomarkers in the control group and Catenibacterium and Lachnospiraceae NK4A136 group to be the major biomarkers in the DB group. To explore the performance of these optimal marker models, receiver operational characteristic curve analysis was performed, and the average area under the curve value of Burkholderia-Caballeronia-Paraburkholderia was 0.7448. Burkholderia cepacia isolated from normal human eyelashes was fermented, and the Demodex mites isolated from patient eyelashes were cultured together with its fermented supernatant. The results showed that the fermentation supernatant could significantly reduce the survival time of the Demodex mites, suggesting the potential therapeutic value of this bacterium against Demodex. Conclusions: The composition of the bacterial community in the eyelashes of DB patients differed from that in eyelashes of healthy volunteers, revealing a decrease in bacterial diversity in infested eyelashes. This decrease may be related to the occurrence and development of DB. The supernatant of Burkholderia cepacia culture medium was found to inhibit the growth of Demodex in eyelash hair follicles, providing a new insight with potential applications for the clinical treatment of Demodex infestation. [ABSTRACT FROM AUTHOR]

Blepharitis is a common chronic inflammatory condition affecting the eyelid margins; the pathophysiology of blepharitis is complex and not fully understood. The disease is anatomically divided into anterior (inflammation of eyelashes) and posterior (meibomian gland dysfunction) types. Diagnosis relies on clinical examination, revealing characteristic features like scurf, vascular changes, and meibomian gland dysfunction. The main goals of blepharitis treatment are symptom relief, recurrence prevention, and complication risk minimization. Treatment options include lid hygiene, topical and systemic antibiotics, topical corticosteroids, and omega-3 supplements. However, it is important to highlight reported cases of blepharitis as side effects of systemic therapies, particularly in the context of chemotherapy, bortezomib, cetuximab, TNFα inhibitors, and dupilumab. It is crucial to monitor patients undergoing such treatments regularly and attentively in order to promptly set up adequate supportive therapy. Of even more importance is future research on the pathophysiological mechanisms responsible for the occurrence of these ocular side effects in order to find a nosological cure for the issue. [ABSTRACT FROM AUTHOR]

This was a pilot study to evaluate the efficacy of digital polymerase chain reaction detection of Demodex in eyelid margin swabs for the diagnosis of Demodex blepharitis. This study aims to explore the possibility of digital polymerase chain reaction detection to improve the diagnostic accuracy of Demodex blepharitis detection. Volunteers were prospectively recruited and classified by experienced doctors into suspected Demodex blepharitis or healthy controls using slit-lamp evaluation of the eyelid margin and an inquiry about symptoms. Three eyelashes from each eyelid were epilated from participants in each group for microscopic observation and mite counting. Then, swabs from the eyelid margins of each eye were collected after the eyelashes were epilated and stored at –80 °C for future DNA extraction and digital polymerase chain reaction detection. The positive or negative results of both methods were compared for diagnostic accuracy, and the Kappa value was also calculated to evaluate their consistency. The accuracy of the digital polymerase chain reaction detection was 71.6% and that of the mite counting method was 75%. Their combined accuracy was improved to 77.3%. The Kappa value of the two methods was 0.505, indicating moderate consistency. Digital polymerase chain reaction detection of Demodex from ocular surface swabs was painless and noninvasive and is a potentially accurate quantitative method available for diagnosing Demodex blepharitis. This method is also complementary to the conventional mite counting method, particularly when a sufficient number of eyelashes cannot be effectively epilated. [ABSTRACT FROM AUTHOR]

Introduction: Ipilimumab and nivolumab are checkpoint inhibitors that are known to cause a multitude of inflammatory ocular adverse events. Here we report a patient with poliosis and symptomatic depigmentation of the choroid and retinal pigment epithelium (RPE) associated with checkpoint inhibitor therapy for cutaneous melanoma. Case Presentation: The patient presented with floaters in both eyes and concerns for intraocular metastases of metastatic cutaneous melanoma after 1 month of therapy with ipilimumab and nivolumab. External examination revealed poliosis of her eyebrows and eyelashes. Fundus photography demonstrated multiple 1–3 disc-diameter hypopigmented placoid flat areas in the RPE/choroid exposing underlying choroidal vessels in both eyes. At subsequent evaluation 7 months later (after an additional 6 months of checkpoint inhibitor therapy), the lesions appeared more blanched. Evaluation nearly 20 months after the initial presentation showed no significant changes from her prior visit despite cessation of checkpoint inhibitor therapy for 13 months. Conclusion: Checkpoint inhibitor therapy for cutaneous melanoma metastases can cause depigmentation of the choroid and RPE that must be differentiated from progression of intraocular melanoma. [ABSTRACT FROM AUTHOR]

Alternative reproductive strategies typically involve the use of divergent suites of morphological and behavioural traits to maximize reproductive success. The genetically determined male morphs of the jumping spider Maevia inclemens have dramatically different secondary sexual traits and courtship behaviour, the functions of which remain elusive despite extensive research. Building on a previous study, here we tested the following two hypotheses that might explain their drastically different morphology and behaviour: (1) males of the tufted morph may use tufts on their head to signal their mate quality to females; (2) males of the striped morph may use contrasting black-and-white striped legs to suppress female aggression during courtship. To test these hypotheses, we manipulated the tuft lengths of tufted males and presence/absence of leg stripes on striped males. We paired the manipulated males with unmated females and quantified various measures of mating success, female receptivity, female aggression and reproductive output. Despite extensive analyses, we found little support for our a priori hypotheses. Instead, our models suggested that male body condition is more likely to influence the outcome of mating interactions than variation in the target traits we manipulated. These robust negative results allow us to revise our hypotheses and provide new insight into this unique male dimorphism that has puzzled biologists for decades. They also provide a broad context for thinking about the evolution and maintenance of other unusual cases of male dimorphism across taxa. • The two male morphs of Maevia inclemens (tufted and striped) look and behave differently. • For tufted males, we manipulated tuft lengths using false eyelashes. • For striped males, we manipulated the presence or absence of leg stripes using make-up. • Our manipulations had no effect on male mating success or aggression from females. • A male's body condition was a better predictor of his success than our manipulations. [ABSTRACT FROM AUTHOR]

Background Alopecia areata is an autoimmune dermatosis characterized by non-scarring loss of hair, especially hair, beard, eyebrows and eyelashes. In this case-control study, we investigated the relationship between vitamin D levels and the disease and the type of involvement (patchy, diffuse, total and universal). Methods Forty one non-pregnant and over 18 years of age alopecia areata patients, who applied to the dermatology outpatient clinic of our hospital between 08.03.2016 and 31.05.2016 and who gave informed consent after being given verbal and written information about the study, were included in the study. The control group included 41 non-pregnant people over the age of 18 who applied to the outpatient clinic with complaints other than alopecia areata, matched with the patient group in terms of gender and age. Results There was no statistically significant difference in vitamin D levels between the control and patient groups, as well as between groups separated according to the type of involvement (p=0.06 and 0.72, respectively). There was no significant difference between the 2 groups with normal and low (<30ng/ml) vitamin D in terms of both disease and extent patterns (p=0.11 and 0.37, respectively). When all participants were divided into 3 groups in terms of vitamin D levels: normal, borderline low (20-29.9 ng/ml) and low (<20ng/ml), no statistically significant difference was found in terms of disease and extent patterns (p=0.17 and 0.33, respectively). Conclusion In our study, no statistically significant connection was found between the disease and the extent of involvement in terms of mean vitamin D levels and low vitamin D levels. [ABSTRACT FROM AUTHOR]

Featured Application: In this study, we report on fast and robust autofocus for non-mydriatic fundus photography under less stringent imaging conditions. Based on image sharpness evaluations, the adaptive focus window and path-optimized search are used to detect the focus position accurately. This method can be applied to fundus cameras or similar ophthalmic instruments, effectively alleviating imaging challenges posed by patients with fixation difficulties. Non-mydriatic fundus photography (NMFP) plays a vital role in diagnosing eye diseases, with its performance primarily dependent on the autofocus process. However, even minor maloperations or eye micro-movements can compromise fundus imaging quality, leading to autofocus inaccuracy and a heightened risk of misdiagnosis. To enhance the autofocus performance in NMFP, a fast and robust fundus autofocus method with adaptive window and path-optimized search is proposed. In this method, the adaptive focus window is used to suppress irrelevant image contents and correct the sharpness curve, and the path-optimized search is constructed to overcome the curve's local extrema, in order to achieve rapid focus position convergence. This method was simulated and clinically studied with the self-developed autofocus system for NMFP. The results of 80 cases of human eye imaging show that, compared with similar autofocus methods, this method achieves a focus success rate of 90% with the least axial scanning, and can adapt to non-ideal imaging conditions such as pupil misalignment, eyelash occlusion, and nystagmus. [ABSTRACT FROM AUTHOR]

Lymphedema-distichiasis syndrome (LD, OMIM 153400) is hereditary primary lymphedema with autosomal dominant nature of inheritance and variable expression. LD is characterized by late childhood or pubertal onset of lower limb lymphedema and an aberrant second row of eyelashes (distichiasis) arising from the meibomian glands. Among the molecular reasons behind this condition are the mutations in the FOXC2 gene, a forkhead transcription factor, that plays a role in the formation of lymphatic and vascular systems. In this study, we report the first case of LD from Bangladesh with classical lymphedema-distichiasis syndrome with an eight-base-pair deletion in the FOXC2 gene. ClinVar accession code for this deletion is RCV000007679.3. FOXC2 protein is 501 amino acids long. This deletion of 8 bp (ACGCCGCC) causes frameshift of codons after amino acid number 304. The frameshift creates an altered truncated protein with 154 new amino acids after codon 304. We assume that these changes in the protein may affect its function contributing to the disease manifestations. Further research may confirm these assumptions. [ABSTRACT FROM AUTHOR]

Objectives: The present analyses report integrated results from BRAVE-AA1 (NCT03570749) and BRAVE-AA2 (NCT03899259) on the clinical benefits of baricitinib treatment on the basis of the amount of scalp hair regrowth through 52 weeks of treatment. Methods: This post hoc analysis was conducted with data from patients who were treated continuously for 52 weeks with baricitinib 4 mg or 2 mg. Clinical outcomes were assessed using the Severity of Alopecia Tool (SALT) and Clinician-Reported Outcome (ClinRO) for Eyebrow (EB) and Eyelash (EL) hair. Secondary measures included the Hospital Anxiety and Depression Scale and Skindex-16 adapted for alopecia areata. At week 52, patients were classified into three subgroups: SALT ≤ 20 response, intermediate response (achieved a 30% improvement from baseline (SALT30) without a SALT score ≤ 20), or nonresponse (never achieved SALT30). The criterion of SALT30 approximates a minimal clinical meaningful response to therapy. Results: At week 52, with baricitinib 4 mg treatment, the greatest (70%) improvement in EB and EL was observed in responders, but approximately 50% of patients with intermediate response and 20% of nonresponders experienced complete/nearly complete EB and EL regrowth. Improvement in emotional distress was directionally related to improvements in scalp hair regrowth, while impact on quality of life was proportionately greater for the responder subgroup. Conclusions: Clinically meaningful regrowth in eyebrow and eyelash hair can occur in the absence of complete scalp hair regrowth after treatment with baricitinib. Emotional distress and quality of life improvement is most associated with obtaining a clinical meaningful improvement in scalp hair. Trial Registration Number: BRAVE-AA1, ClinicalTrials.gov number, NCT03570749, start date, 24 September 2018; BRAVE-AA2, ClinicalTrials.gov number, NCT03899259, start date, 8 July 2019. [ABSTRACT FROM AUTHOR]

GAPO syndrome (growth retardation, alopecia, pseudoanodontia, optic atrophy) is a rare, autosomal recessive connective tissue disorder with only 60 reported cases. Ophthalmic manifestations vary and include hypertelorism, optic atrophy, and glaucoma. There have been three reported cases of GAPO syndrome with craniosynostosis. We describe two new siblings with GAPO syndrome and craniosynostosis and the first histopathologic analysis of Tenon's capsule and extraocular muscle in this syndrome. Both siblings presented with papilledema and V-pattern strabismus in addition to the alopecia, brittle eyelashes, growth retardation, and pseudoanodontia that characterize GAPO syndrome. Cranial vault expansion, though successful, was complicated by lack of distinct periosteal layers, thin dural adherence to bone, and extensive venous bleeding. Tenons encountered during strabismus surgery was inelastic and highly vascular. Histopathological analysis revealed hyalinization of Tenon's and a thickened, homogenized, amorphous appearance, similar to the extracellular matrix abnormalities described in skin and other organs Histopathological analysis of extraocular muscle was, in contrast, unremarkable. GAPO impacts the extracellular matrix of Tenon's resulting in inelasticity and hypervascularity. Ophthalmologists should be mindful of these aberrant characteristics when planning surgery in this population. [ABSTRACT FROM AUTHOR]

We present a case of a child with Floating-Harbor Syndrome (FHS) with bilateral chorioretinal coloboma (CC). To the best of our knowledge, this is the first case report of this association. Floating- Harbor syndrome is an extremely rare autosomal dominant genetic disorder with approximately 100 cases reported. It is characterized by a series of atypical features that include short stature with delayed bone age, low birth weight, skeletal anomalies, delayed speech development, and dysmorphic facial characteristics that typically portray a triangular face, deep-set eyes, long eyelashes, and prominent nose. Our patient was examined by a pediatric ophthalmologist for the time at age of 7. Visual acuity, optical coherence tomography (OCT) and Optos imaging were collected on every visit. The patient had whole genome sequencing ordered by a pediatric geneticist to confirm Floating-Harbor syndrome. We present the patient's OCT and Optos images that illustrate the location of the patient's inferior chorioretinal coloboma in both eyes. The whole genome sequencing report collected revealed a heterozygous de novo pathogenic variant in the SRCAP gene, consistent with a Floating-Harbor syndrome diagnosis in the literature. Both genetic and systemic findings are consistent with the diagnosis of Floating-Harbor syndrome in our patient. Rubenstein-Taybi and Floating-Harbor syndrome share a similarity in molecular and physical manifestations, but because of the prevalence in Rubenstein-Taybi diagnoses, it is a syndromic condition that includes coloboma and frequently associated with each other. Therefore, a retinal exam should become part of the standard protocol for those with FHS, as proper diagnosis, examination and treatment can prevent irreversible retinal damage. [ABSTRACT FROM AUTHOR]

Jing Nie, Xue Shen, Yan Li, Wenju Wang Department of Dermatology, Chengdu Second People’s Hospital, Chengdu, Sichuan, 610000, People’s Republic of ChinaCorrespondence: Jing Nie, Department of dermatology, Chengdu Second People’s Hospital, 165 Caoshi Street, Qingyang District, Chengdu, Sichuan, 610000, People’s Republic of China, Tel +86-15902687253, Email niejing122402@163.comAbstract: Pediculosis has been reported in all countries and socio-economic classes. Due to the small size and translucent nature of their nits, patients with Pthirus pubis may be misdiagnosed. Here, we report three cases of Pthirus pubis infection involving different body sites, including the eyelashes, axillary region and head, respectively. This case series have discussed their clinical features and corresponding responses. A large number of eggs and adult pubic lice were observed under dermoscopic observation, which can be considered an effective tool for diagnosing Pthirus pubis and reducing the misdiagnosis rate.Keywords: Phthirus pubis, eyelashes, axillary region, head, dermoscopy

This study aimed to investigate the impact of ocular demodicosis on dry eye disease (DED) and meibomian gland dysfunction (MGD) across different age populations: young (20 to < 40), middle-aged (40 to < 60), and elderly (≥ 60), based on the retrospective medical chart review. In each age subgroup, Demodex infestation and its count were correlated with clinical parameters of DED and MGD. Among the total of 351 subjects, 52.7% had ocular demodicosis, with a mean of 2.31 ± 1.39 mites per four eyelashes (0.58 per lash) in a unilateral eye. In the age subgroup 1 (age < 40; N = 44), subjects with Demodex had significantly higher meibum quality grades. In subgroup 2 (40 ≤ age < 60; N = 122), subjects with Demodex had higher ocular surface disease index scores and higher MG expressibility grades. However, in subgroup 3 (age ≥ 60; N = 185), demographics and all parameters did not differ according to Demodex infestation. Moreover, the number of mites did not correlate with MGD severity in any of the subgroups. In conclusion, age may act as a significant confounding factor in the relationship between ocular Demodex infestation and clinical features of DED and MGD, despite older patients aged 60 years and above being at a higher risk of Demodex infestation and experiencing more severe MGD. [ABSTRACT FROM AUTHOR]

Eyelashes evolved to protect eyes. An optimum eyelash length functions to protect eyes from external hazards such as contaminations, excessive evaporation or shear stress from airflow. They can also be an indicator of a person's health as various congenital and noncongenital diseases can lead to short or long eyelashes. The current study aimed to extend a recent investigation on the preference for eyelash length in humans from an evolutionary adaptive perspective. Specifically, the current study tested whether the inverted-U function for eyelash length preference recently reported for White faces, generalises to other ethnicities, and whether ethnic background modulates preference for eyelash lengths. To investigate this question, men and women of Asian, Black, and White ethnicities from the U.S. rated the attractiveness of female Indian, Asian, Black, and White faces with varying eyelash lengths. The eyelashes ranged in length from no eyelashes to half the width of an eye. Results showed that Asian, Black, and White men and women preference for eyelash length followed an inverted-U function across all four ethnicities, supporting a general preference for human eyelash length that is approximately one-third the width of an eye. In addition, the results showed that the most attractive eyelashes for Black women were skewed toward a greater eyelash-length to eye-width ratio when compared to the other images. The source of this skew is presently unknown, as it could reflect a change in perceptual sensitivity to eyelash length with skin colour or changes in preference related to perceptions of participants' ethnicity. [ABSTRACT FROM AUTHOR]

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

Eyelashes, in addition to fulfilling eye-protective functions, generate an aesthetic impact. Latanoprost is a prostaglandin analog, commonly used for the treatment of glaucoma and intraocular hypertension. The side effect reported most often is the stimulation of eyelash growth. The aim of this study was to evaluate the efficacy and safety of latanoprost in inducing eyelash growth and darkening. Thirty healthy volunteers were recruited in a 3-month, randomized, double-blind, placebo-controlled pilot study. A transparent eyelash mascara was used as a vehicle. The placebo group (n = 15) received only the vehicle, and the latanoprost group (n = 15) received the vehicle + 0.005% latanoprost. The participants were asked to apply the latanoprost topically to the eyelashes while avoiding entry into the eye, daily at night. The latanoprost group showed a significant increase in eyelash length and color change, while the placebo group maintained eyelash length and color throughout the study. The intraocular pressures of all the participants were maintained in normal ranges (10–20 mmHg). Topical application of both the placebo and the latanoprost medications was well tolerated; none of the participants withdrew, generated side effects, or developed any ophthalmic pathology. In conclusion, latanoprost is effective and safe to stimulate the growth of eyelashes. [ABSTRACT FROM AUTHOR]