The microbiome and the eye: a new era in ophthalmology.

The human microbiome has progressively been recognised for its role in various disease processes. In ophthalmology, complex interactions between the gut and distinct ocular microbiota within each structure and microenvironment of the eye has advanced our knowledge on the multi-directional relationships of these ecosystems. Increasingly, studies have shown that modulation of the microbiome can be achieved through faecal microbiota transplantation and synbiotics producing favourable outcomes for ophthalmic diseases.

Topical Chloramphenicol in Ophthalmology: Old is Gold.

Purpose: Topical chloramphenicol is one of the most ubiquitous antibiotics used in ophthalmology and oculoplastic surgery globally. It shows broad-spectrum activity against a variety of different pathogenic organisms, is well tolerated on the ocular surface and displays excellent topical pharmacokinetics. Chloramphenicol has been available for purchase over the counter in the United Kingdom since 2005.

Real or MADE-up: Investigating Mask-Associated Dry Eye (MADE) as an emerging syndrome.

Mask-Associated Dry Eye (MADE) has emerged as a consequence of widespread face mask usage during the Covid-19 pandemic. This review critically assesses the available evidence. A comprehensive search on PUBMED and EMBASE was conducted to identify studies on MADE, which were then categorized based on their design.

Horizontal shortening of the lower eyelid margin in facial nerve palsy.

Background/objectives: To determine whether horizontal lower eyelid margin length shortens following facial nerve palsy (FNP).

Subjects/methods: A single-centre retrospective audit of lower eyelid margin horizontal length, measuring from the lower lacrimal punctum to lateral canthal angle with a straight plastic ruler, with the eyelid on gentle stretch ('punctum-to-canthus (PC) distance'), recorded in all FNP patients reviewed in July-September 2021. Affected and fellow eyes were compared using parametric testing.

Plastic orbital foreign body: the rise of plastic and its unintended consequences.

Intraorbital foreign bodies (IOrFBs) are a significant cause of ocular morbidity. Although plastic IOrFBs are rare, the increasing use of plastic and polymer composites in motor vehicles will increase their prevalence. Although challenging to identify, plastic IOrFBs have unique radiographic characteristics.

Interdisciplinary Protocol for the Management of Vision-Threatening Papilledema.

Background: This study evaluates the effectiveness of a multidisciplinary protocol for management of patients with papilledema and vision loss secondary to increased intracranial pressure.

Methods: Retrospective record review of all adult patients who presented with vision-threatening papilledema (VTPE) and were treated under this protocol. Patients are admitted for lumbar drain placement and diuretics and followed daily to determine if they may be managed medically or require surgery (optic nerve sheath fenestration [ONSF] and/or cerebrospinal fluid [CSF] shunting).

Diplopia Following the Insertion of a Canalicular Bypass Tube: Etiology, Risk Factors, Management, and Outcomes.

Purpose: To report the etiology, management, and possible risk factors for diplopia after canalicular bypass surgery.

Methods: A multicenter retrospective, noncomparative case series of patients who developed diplopia following canalicular bypass surgery were assessed.

Results: Twenty-four cases of diplopia were identified across 12 institutions.

Adenoid Cystic Carcinoma of the Eyelid Can Locally Recur and Mimic Basal Cell Carcinoma: Case Report and Review of the Literature.

Adenoid cystic carcinoma (ACC) of the eyelid is a very rare tumor, and only 11 cases have been previously reported in the literature. Here the authors report the 12th case of eyelid ACC that was initially diagnosed as adenoid basal cell carcinoma. This is the first report of local recurrence after wide local excision using the Mohs technique.

An unusual case of idiopathic calcinosis of the eyelid.

Idiopathic subepidermal calcinosis, also known as idiopathic calcinosis cutis, is a rare condition, which typically presents as a small, hard, subepithelial mass in the absence of systemic disease and trauma. We report on an atypical case of idiopathic calcinosis, which appeared in an otherwise healthy 61-year-old female along the tarsus of her right upper eyelid. The purpose of this case report is to demonstrate idiopathic calcinosis in an unusual location that is deep to the dermis and to discuss the vast differential diagnosis of this entity.

The kissing puncta: an under-reported and stubborn cause of epiphora.

Background: 'Kissing puncta' (KP) or punctal apposition is an anatomical phenomenon sparsely reported in the English literature. We describe our experience of managing chronic epiphora in patients with punctal apposition.

Methods: A retrospective audit of five patients (nine eyes) with KP associated with epiphora.

Subepidermal Calcinosis in the Ocular Adnexa: A Systematic Review.

Purpose: To review the clinical and histopathologic findings associated with subepidermal calcinosis of the eyelids.

Methods: A systematic review of the literature on subepidermal calcinosis of the eyelids was performed. Cases included were idiopathic in nature and met the histologic criteria for subepidermal calcinosis with calcium deposits in the dermis of the skin.

In Praise of Precision: Esoglobus and Exoglobus.

Precise description of clinical findings is a sine qua non of effective communication and documentation in medicine. To that end, there have not, to date, been accurate words to describe lateral or medial displacement of the globe. Such displacements are frequently seen with orbital disease.

Undifferentiated Nonrhabdomyosarcoma Soft Tissue Sarcoma of the Orbit.

A 6-month-old boy presented with recurrent, poorly differentiated orbital sarcoma diagnosed as nonrhabdomyosarcoma soft tissue sarcoma, as pathologic and immunohistochemical evaluation was inconsistent with rhabdomyosarcoma or other specific sarcoma subtypes. He responded favorably to a treatment regimen for poorly differentiated sarcomas.

Reversible Blindness Following Orbital Fracture Repair.

The authors report a case of a 72-year-old woman with unilateral, complete, reversible blindness (no light perception) immediately after uncomplicated repair of an orbital floor fracture. In this case, vision loss was reversed with prompt surgical intervention with removal of the orbital floor implant. The authors review the etiology of vision loss after orbital fracture repair and hypothesize as to the cause of blindness in this case.

Review: The Lacrimal Gland and Its Role in Dry Eye.

The human tear film is a 3-layered coating of the surface of the eye and a loss, or reduction, in any layer of this film may result in a syndrome of blurry vision and burning pain of the eyes known as dry eye. The lacrimal gland and accessory glands provide multiple components to the tear film, most notably the aqueous. Dysfunction of these glands results in the loss of aqueous and other products required in ocular surface maintenance and health resulting in dry eye and the potential for significant surface pathology.

Optic Nerve Fenestration in a Patient With the Syndrome of Acquired Hyperopia and Choroidal Folds.

We performed bilateral optic nerve sheath fenestrations on a patient with the syndrome of acquired hyperopia and choroidal folds. We are unaware of previous reports of this procedure being performed in this clinical setting. Despite the incomplete resolution of his posterior segment findings postoperatively, the results of the procedure, along with an understanding of the relevant anatomy, may help to shed light on the pathogenesis of this rare entity.

Intraorbital Irrigation of Amphotericin B in the Treatment of Rhino-Orbital Mucormycosis.

The aim of this study was to describe a modified technique of intraorbital irrigation of amphotericin B in the treatment of rhino-orbital mucormycosis. A 38-year-old man was diagnosed with rhino-orbital mucormycosis and subsequently underwent orbital and sinus debridement with postoperative intraorbital irrigation of amphotericin B. Daily irrigation of amphotericin B was infused in the orbit with measures taken to avoid iatrogenic toxicity to the ocular surface and gastrointestinal tract.

Thymic Origin Neuroendocrine Carcinoma Metastasizing to the Orbit in an Otherwise Asymptomatic Patient.

A 39-year-old man without a significant medical history developed headaches, OS swelling, and limited left-sided ocular motility. An ultrasound of the left orbit and head MRI revealed a retro-orbital mass. A partial left anterior orbitotomy with partial resection was performed, and histopathologic examination of the resected tumor portion was suggestive of a neuroendocrine carcinoma.