Orbital Disease Research Articles

Controversies Surrounding IGF-I Receptor Involvement in Thyroid-Associated Ophthalmopathy.

Background: Thyroid-associated ophthalmopathy (TAO, aka thyroid eye disease [TED], Graves' orbitopathy) remains poorly understood and inadequately treated since its initial description. It is disfiguring, can threaten vision, and represents an autoimmune process closely associated with thyroid disease. Unambiguous connections linking TAO to the glandular maladies of Graves' disease (GD) remain incompletely clarified. Detecting the thyrotropin receptor (TSHR) in periocular tissues suggests that this cell-surface protein represents a shared autoantigen with the thyroid gland, but we now know that its expression is ubiquitous. Most patients with TAO have relatively high circulating levels of activating anti-TSHR autoantibodies. Emerging more recently is the importance of insulin-like growth factor I receptor (IGF-IR) in the pathogenesis of TAO. The TSHR/IGF-IR signaling complex apparently drives circulating fibrocytes and the unique phenotypes of fibroblasts inhabiting the TAO orbit (GD-OF). Methods: The PubMed database was scanned for articles dating back to the earliest time periods covered. Keywords used for primary searches included thyroid-associated ophthalmopathy, Graves' orbitopathy, TED, orbit, TSH receptor, IGF-I receptor, and autoimmune thyroid disease. Secondary searches used numerous other search terms. Results: GD-OF have been characterized extensively as being particularly responsive to the immunological factors and key effectors in TAO pathogenesis. Both TSHR and IGF-IR are overexpressed by GD-OF and CD34+ fibrocytes and form a signaling complex. They are activated through this TSHR/IGF-IR complex to produce large amounts of hyaluronan and express multiple cytokines. This complex mediates cellular responses to pathogenic IgGs in TAO. CD34+ fibrocytes and CD34+ OF also express relatively high levels of multiple thyroid autoantigens. Identifying IGF-IR as a key component of a receptor complex and its intertwining signaling activities with those of TSHR has led to a targeted medical therapy for TAO. This therapy involves the selective systemic inhibition of IGF-IR. Conclusions: Much has been learned over the preceding decades about the pathogenesis of TAO. Among these is the identification of IGF-IR as a pivotal component underpinning the disease. This has led directly to development of an effective targeted therapy. Important gaps in our understanding persist, and current therapies have limitations. Thus, despite these advancements, considerably more remains to be achieved.

Orbital chloroma mimicking as idiopathic orbital inflammatory disease.

Orbital chloroma mimicking as idiopathic orbital inflammatory disease.

Risk Factors for Ectropion After Lower Eyelid and Cheek Reconstruction Following Mohs Micrographic Surgery.

Development of ectropion is a frequently reported complication after reconstruction of infraorbital Mohs defects. This study aimed to characterize preoperative and surgical factors contributing to ectropion development in patients undergoing reconstruction after Mohs micrographic surgery. We conducted a retrospective single-center case-control study on patients undergoing reconstruction of Mohs micrographic surgery defects involving the nonmarginal lower eyelid and upper cheek from 2011 to 2023. Pre- and postoperative photographs were reviewed to confirm defect location and postreconstructive eyelid malposition. Ectropion risk factors were determined with uni- and multivariate odds ratio analyses. A total of 202 patients were included, 45 cases in the ectropion group and 157 in the control group. Negative orbital vector (P = 0.02), recurrent disease (P = 0.01), and greater defects size (P = 0.007) were associated with postreconstructive ectropion. Ectropion was more likely after multidisciplinary reconstruction (13.3% versus 1.4%, P < 0.001) and reconstruction with cervicofacial flaps (28.9% versus 4.2%, P < 0.0005); and less likely after primary closure (8.9% versus 28.5%, P < 0.001). Multivariate assessment (odds ratio [95% confidence interval], P value) revealed that combined cheek and eyelid defect involvement (4.32 [1.36-13.6], P = 0.01), larger size (1.07 [1.03-1.13], P < 0.001), and negative orbital vector (12.11 [2.65-65.42], P = 0.002) were independent risk factors for ectropion development. Combined cheek/lower eyelid defects and negative orbital vector increase the risk of postreconstructive ectropion. These findings can be used to optimize surgical technique and counsel patients on increased likelihood of this complication with possible need for revision surgery.

Extranodal natural killer/T-cell lymphoma with secondary haemophagocytic lymphohistiocytosis simulating orbital inflammatory disease

This case report describes an uncommon case of periorbital swelling due to a rare neoplastic condition, a natural killer/T-cell lymphoma, which presented a significant diagnostic challenge. The malignancy was complicated by hemophagocytic lymphohistiocytosis that led to mortality within a month of initial presentation.

Orbital inflammatory disease: a joint clinical experience in rheumatology and ophthalmology.

This retrospective study aimed to characterize the clinical features, histopathological findings, and treatment outcomes of patients diagnosed with orbital inflammatory disease (OID) co-managed by the rheumatology and ophthalmology departments in a tertiary hospital. Medical records of 14 patients with OID were analyzed. Data on demographics, clinical presentation, laboratory investigations, radiological imaging, histopathological results, treatment regimens, and disease outcomes were collected and reviewed. The mean age of the patients was 34.5years, with a female (71.4%) predominance. Periorbital pain (62.5%), periorbital edema (50%) and diplopia (50%) were the most common presenting symptoms. Histopathological evaluation revealed diverse subtypes, including non-specific orbital inflammation (NSOI) (42.8%), orbital myositis (28.5%) and IgG4-related disease (14.3%). Initial treatment with systemic corticosteroids achieved remission in 14.3% of patients, while 85.7% required additional immunosuppressive therapy. Radiotherapy was effective in one patient unresponsive to steroid and azathioprine treatment. OID presents with diverse clinical manifestations and histopathological subtypes, often requiring multidisciplinary management. While corticosteroids remain the first-line therapy, adjunctive immunosuppressive agents or radiotherapy may be necessary in refractory cases.

Spectrum of metastatic tumours to orbit over the last twenty years in a tertiary care eye hospital-A retrospective study

Objective: To assess the type and presentation patterns of tumours metastasising to orbit. Method: The retrospective study was conducted at the Al Shifa Trust Eye Hospital, Rawalpindi, Pakistan, and comprised data of all patients with orbital metastatic lesions over a 20-year period, from January 1, 2004, to December 31, 2023. Data was analysed using SPSS 22. Results: Of the 30 patients, 17(56.7%) were males and 13(43.3%) were females. The highest incidence of orbital metastatic disease was among those aged &lt;10 years 9(30%) and &gt;60 years 11(36.7%). Roof was the commonest site of involvement within the orbit 13(43.3%). Proptosis was the main feature at presentation. Diagnosis was made clinically in 14(46.7%) patients and histologically in 16(53.3%). All the 30(100%) cases were referred to the oncology service for further management. Of them, 2(6.7%) patients were lost to follow-up, 20(66.7%) died within one year of diagnosis, and 8 (26.6%) patients were still under treatment. Conclusion: The diagnosis of orbital metastasis should always be considered for orbital lesions in all age groups, especially in patients with a known cancer elsewhere. Orbital metastasis usually becomes evident at an advanced stage of underlying malignancy, leading to a high mortality rate. Key Words: Orbital metastasis, Orbital tumours, Orbital malignancies.

Guidelines for standard operation of imaging modalities in orbital diseases (2024).

Orbital disorders include conditions originating from the orbital bones, surrounding tissues, and post-orbital septum. They also include systemic ailments affecting the orbit. Different clinical symptoms make up the complex range of orbital disorders. Because these disorders mostly impact the orbital area instead of the intraocular compartment, there is little diagnostic usefulness for typical ophthalmic visual tests. As such, the vital instruments for diagnosing and evaluating orbital illnesses have become ophthalmic imaging modalities, including ocular ultrasonography (B-scan), computed tomography (CT), and magnetic resonance imaging (MRI). One way to improve the precision and promptness of diagnosing orbital diseases is to standardize the functioning of widely used imaging equipment and define the radiological features of orbital abnormalities. Such programs are crucial for the care of patients with orbital disorders since they considerably reduce the number of misdiagnoses and missed diagnoses in these individuals. The underlying concepts, operational techniques, and normal and pathological imaging findings associated with common diagnostic tools for orbital illnesses are all thoroughly reviewed in this guideline. The objective is to improve primary healthcare settings' diagnostic competence in the field of orbital pathology and to standardize procedures for diagnosing orbital disorders.

Paediatric IgG4 related ophthalmic disease (IgG4-ROD) presenting as bilateral dacryoadenitis. A case report

A 15-year-old male presented with recurrent, episodic, bilateral eyelid swelling over two days. On examination, he exhibited bilateral eyelid edema, a superotemporal mass, proptosis, and limitation in extraocular motility. Laboratory findings revealed elevated ESR, CRP, and IgG4 serum levels, with negative ANA, ANCA, and ACE. MRI reported symmetrical enlargement of the lacrimal glands with homogeneous enhancement and diffuse restriction. The diagnosis was orbital IgG4-related disease (IgG4-RD) manifesting as bilateral dacryoadenitis, which responded remarkably to systemic steroids. After two years of treatment with immunosuppressants, he experienced no relapses. We share this case to alert clinicians to IgG4-related orbitopathy (IgG4-ROD) in young patients, so that prompt diagnosis and management can be instituted for optimal results.

Derived Neutrophil-to-Lymphocyte and Neutrophil-to-Platelet Ratios Distinguish Sinusitis-Related Orbital Cellulitis From Periorbital Necrotizing Fasciitis.

Periorbital necrotizing fasciitis (NF) and sinusitis-related orbital cellulitis (OC) present with common clinical features, although the management algorithms for these ailments vary considerably. Previous investigations have failed to identify biomarkers that distinguish between these entities. This study was designed to explore the role of the derived neutrophil-to-lymphocyte and neutrophil-to-platelet ratios in discerning NF from OC. The derived neutrophil-to-lymphocyte and neutrophil-to-platelet ratios were calculated in nonimmunocompromised adult patients with NF and OC from the first blood draw upon presentation to the emergency department at a single academic medical center. Mann-Whitney nonparametric analyses and the area under the receiver-operator curve were analyzed via a dedicated computerized software package. A total of 16 patients with NF (mean age = 54.5 years) and 12 patients with OC (mean age = 50.8 years) were identified. The mean derived neutrophil-to-lymphocyte ratios were 5.74 (standard deviation = 4.20) and 2.36 (standard deviation = 1.75) for NF and OC, respectively (p = 0.0037), resulting in an area under the receiver-operator curve of 0.82 (95% confidence interval = 0.66-0.98). The mean neutrophil-to-platelet ratios were 0.073 (standard deviation = 0.044) and 0.020 (standard deviation = 0.0084) for NF and OC, respectively (p < 0.001), yielding an area under the receiver-operator curve of 0.92 (95% confidence interval = 0.80-1.00). In nonimmunocompromised adult patients, the derived neutrophil-to-lymphocyte ratio and neutrophil-to-platelet ratio both appear to distinguish NF from OC. While further study is required in larger cohorts to ensure the robustness of these findings, these initial results suggest that these biomarkers may be coupled with appropriate examinations to diagnose patients with these conditions and initiate the appropriate steps in the management of patients with orbital infectious disease.

The Relevance and Potential Role of Orbital Fat in Inflammatory Orbital Diseases: Implications for Diagnosis and Treatment.

The orbit is an important structure within the skull that houses the eye, optic nerve, and extraocular muscles. It also contains adipose/fat tissue, which provides a protective cushion for these components. Inflammatory orbital disease can affect any or all components of the orbit, often arising from various underlying pathologic conditions, including autoimmune, infectious, and vascular diseases. Typical signs and symptoms of orbital inflammation include swelling, redness, pain, discomfort, and potential loss of function. The role of orbital fat in the pathogenesis of inflammatory orbital diseases has not been fully explored. This review aims to provide a comprehensive description of orbital fat, its relevance and the potential role in inflammatory diseases of the orbit, and the use of radiologic imaging studies for evaluating this fat depot in cases of as inflammatory orbital diseases. Additionally, this review discusses the various procedures available for the treatment and management of these conditions. A range of interventions, including pharmacotherapy and surgical procedures, will be evaluated as promising therapeutic options. This review also explores the characteristics and potential applications of orbital fat-derived stem cells, with an emphasis on their regenerative abilities and anti-inflammatory effects. Understanding the role of orbital fat and its contribution to inflammatory orbital diseases is essential for optimizing diagnostic and treatment strategies.

Value of Platelet-to-Lymphocyte and Monocyte-to-Lymphocyte Ratios in Differentiating Idiopathic Orbital Inflammation From Orbital Infectious Disease.

Monocyte-lymphocyte ratio (MLR) and platelet-lymphocyte ratio (PLR) are emerging biomarkers; they have not been widely utilized in orbital disease. This study investigated the role of these ratios in distinguishing orbital inflammation from infection. A retrospective review of medical records was conducted to identify adult patients who presented acutely to a single emergency department at an academic medical center and were diagnosed with serologically and biopsy-proven idiopathic orbital inflammation (IOI, n = 9), orbital cellulitis (OC, n = 14), or necrotizing fasciitis (NF, n = 12). MLR and PLR were calculated from the first blood draw on presentation to the emergency department. Statistical analysis was performed via the Mann-Whitney test with a dedicated computerized software package (GraphPad Prism, La Jolla, CA) with p values <0.05 considered statistically significant. Mean PLRs were 194.90 (SD = 118.01), 304.21 (SD = 341.39), and 203.38 (SD = 196.32) for IOI, NF, and OC, respectively. Mean MLRs were 0.40 (SD = 0.24), 1.74 (SD = 2.41), and 0.75 (SD = 0.40) for IOI, NF, and OC, respectively. MLR was significantly lower in the IOI group compared to the NF group (p = 0.018) and OC group (p = 0.020). Differences in MLR between OC and NF groups were not statistically significant (p = 0.43). While MLR showed no significant difference between different infectious etiologies, it was significantly higher in infectious processes than in IOI, distinguishing inflammation from infection. MLR could be a valuable addition to the diagnostic toolkit for triaging patients in the emergency department and initiating prompt, focused therapy.

The Neutrophil-Lymphocyte Ratio in Pediatric Preseptal and Orbital Infectious Cellulitis.

The neutrophil-lymphocyte ratio (NLR) is an important biomarker in a variety of systemic conditions, though its role in orbital disease remains unclear. We sought to investigate the utility of the NLR in distinguishing orbital cellulitis (OC) from preseptal cellulitis (PC) in a pediatric population. The earliest available NLRs of immunocompetent pediatric patients who presented to the emergency department with OC and PC were calculated from a single institution's database. Demographic and interventional data related to each encounter were also gathered. NLRs were compared via the Mann-Whitney test between OC and PC cases. Among patients with OC, the relationship between presenting NLR and requirement for surgical intervention and between presenting NLR and subperiosteal abscess was similarly examined. All statistical analyses were performed in GraphPad Prism 9 (Insight Partners, New York, NY, U.S.A.). Forty-three encounters of patients with OC and 23 encounters of patients with PC were identified. Median presenting NLR for the OC group was 4.18 (standard deviation: 5.44), whereas for the PC group, it was 1.96 (standard deviation: 2.38), representing a significant difference between the 2 groups (p < 0.001). The 26 patients with OC who required surgical intervention had significantly greater presenting NLR (median NLR: 6.53, standard deviation: 6.29) as compared to the 17 patients with OC who were managed medically (median NLR: 3.09, standard deviation: 2.37, p = 0.003). There was no statistically significant difference between 34 patients with OC who had a subperiosteal abscess (median NLR: 4.40, standard deviation: 5.91) and the 9 patients with OC who did not (median NLR: 3.84, standard deviation: 2.37, p = 0.401). An elevated NLR is a useful adjunct to the clinical examination in discerning OC from PC or in risk stratification for patients with OC who may need surgical treatment of their periocular infectious disease. In select cases, a reassuring NLR may allow the cost and radiation exposure associated with radiographic assessment to be avoided.

Thyroid-associated ophthalmopathy and ferroptosis: a review of pathological mechanisms and therapeutic strategies.

Thyroid-associated ophthalmopathy (TAO) is an inflammatory orbital disease associated with autoimmune thyroid disorders. Owing to the ambiguous nature of the pathogenesis, contemporary pharmacological treatment strategies predominantly involve the use of glucocorticoids and immunosuppressants. However, the adverse effects associated with these agents in clinical practice necessitate further investigation into the disease's pathogenesis and the identification of novel therapeutic targets and pharmacological interventions. Recent studies suggest that ferroptosis, a novel form of regulated cell death, may play a role in TAO pathogenesis. This review aims to explore the involvement of ferroptosis in TAO and evaluate its potential as a therapeutic target. Key topics include the epidemiology, clinical manifestations, and pathophysiology of TAO, along with the molecular mechanisms of ferroptosis. Evidence supporting ferroptosis in TAO and the therapeutic implications of targeting this pathway are also discussed, alongside challenges and future directions in this emerging research area.

Geographical distribution of human pythiosis in the USA.

For more than 100 years, the infections caused by Pythium insidiosum have been well documented in horses. However, recently, pythiosis was also described in several species, including dogs, cats, cattle, zoo captive animals, and humans. Human pythiosis is a life-threatening infection requiring an early diagnosis for a successful management. The clinical picture of pythiosis mirrors the clinical features of infections caused by other pathogens, including filamentous fungi, making its diagnosis challenging. This fact had led to several misdiagnosed cases involving filamentous fungal pathogens. The first pythiosis human case in the USA was reported in 1989. Soon after, various pythiosis cases of orbital disease in children and on the limbs of adults were sporadically diagnosed. To investigate the geographical distribution of human pythiosis in the USA, we constructed a density USA map using a recent report of pythiosis in animals highlighting the known human cases. Our data showed that P. insidiosum human infections in the USA are diagnosed in the same geographic areas where animal pythiosis occur. Physicians handling clinical cases like those so far reported can use the geographic distribution of pythiosis human cases in this study as a guide in their clinical diagnosis and in the early management of putative cases.IMPORTANCEThe relevance of the study not only resides in the epidemiological distribution of animal human pythiosis in the USA (our team's recent publication), but also shows physicians the areas where Pythium insidiosum thrive in endemic areas. Our manuscript shows to the medical and veterinary communities the current areas of human and animal pythiosis, an event that could have a direct impact on the epidemiology, diagnosis, and management of pythiosis.

Tear inflammatory cytokine profiles in orbital inflammatory disease.

Tear inflammatory cytokines are a novel biomarker studied in a range of ocular surface diseases, periorbital and orbital conditions. This single-centre prospective study between 2022 and 2024 aims to characterise tear cytokine profiles (Interleukin-1β [IL-1β], IL-2, IL-6, Interferon-γ [IFN-γ] and Tumour Necrosis Factor-α [TNF- α]) in orbital inflammatory disease (OID). OID patients had pre-treatment tear collection via micropipette, and cytokine analysis via multiplex bead array analysis. Thirteen healthy controls with no prior ophthalmic history were enrolled for comparison. Eighteen tear specimens from seventeen OID patients (6 males; mean age: 52.1±17.1-years-old), with one repeat tear sample taken for recurrent contralateral orbital inflammation. Diagnoses included non-specific orbital inflammation (47.1%), IgG4-related orbital disease (17.6%), orbital granulomatosis with polyangiitis (5.9%), giant cell arteritis (5.9%), herpes zoster ophthalmicus with orbital apex inflammation (5.9%), viral dacryoadenitis (5.9%), bacterial dacryoadenitis (5.9%) and orbital inflammation of uncertain cause (5.9%). Overall, OID patients, and specifically those with dacryoadenitis, had greater IL-6 levels compared to controls (P=0.038 and 0.002, respectively). OID with dacryoadenitis had higher IL-1β levels compared to those without (P=0.029). Higher IL-6 levels were observed in idiopathic dacryoadenitis compared to healthy controls (P=0.008, respectively). There is significant variability in tear inflammatory cytokines profiles observed in OID. IL-1β and IL-6 levels may be non-specific markers of dacryoadenitis and may be particularly elevated in idiopathic dacryoadenitis. Tear cytokines may be affected by severity, localisation and pattern of inflammation. The utility of tear cytokines in the monitoring and prognostication of OID remains to be elucidated.

Plasma cell type Castleman's disease of lacrimal gland: a case report and literature review

BackgroundOrbital Castleman's disease is a rare benign lymphoproliferative disorder of extranodal origin.Case presentationA 72-year-old man presented with bilateral upper eyelid swelling. Radiology revealed enlarged lacrimal glands in both eyes. Castleman's disease (plasma cell type) was confirmed by histo-immunochemical examinations after excision of the left orbital mass. No extraorbital involvement was found in systemic evaluation. Postoperatively, corticosteroid therapy was given. After 1 year of follow-up, there was no recurrence in the left orbit, and the swelling of the right eyelid was improved.ConclusionsHere, we report a case of orbital Castleman's disease involving the lacrimal gland bilaterally and summarize previously reported cases. For bilateral orbital masses, the possibility of Castleman's disease should be considered. Before the diagnosis, it is necessary to fully distinguish from other diseases such as IgG4-related eye diseases.

Segmentation-Based Measurement of Orbital Structures: Achievements in Eyeball Volume Estimation and Barriers in Optic Nerve Analysis.

Orbital diseases often require precise measurements of eyeball volume, optic nerve sheath diameter (ONSD), and apex-to-eyeball distance (AED) for accurate diagnosis and treatment planning. This study aims to automate and optimize these measurements using advanced deep learning segmentation techniques on orbital Computed Tomography (CT) scans. Orbital CT datasets from individuals of various age groups and genders were used, with annotated masks for the eyeball and optic nerve. A 2D attention U-Net architecture was employed for segmentation, enhanced with slice-level information embeddings to improve contextual understanding. After segmentation, the relevant metrics were calculated from the segmented structures and evaluated for clinical applicability. The segmentation model demonstrated varying performance across orbital structures, achieving a Dice score of 0.8466 for the eyeball and 0.6387 for the optic nerve. Consequently, eyeball-related metrics, such as eyeball volume, exhibited high accuracy, with a root mean square error (RMSE) of 1.28-1.90 cm3 and a mean absolute percentage error (MAPE) of 12-21% across different genders and age groups. In contrast, the lower accuracy of optic nerve segmentation led to less reliable measurements of optic nerve sheath diameter (ONSD) and apex-to-eyeball distance (AED). Additionally, the study analyzed the automatically calculated measurements from various perspectives, revealing key insights and areas for improvement. Despite these challenges, the study highlights the potential of deep learning-based segmentation to automate the assessment of ocular structures, particularly in measuring eyeball volume, while leaving room for further improvement in optic nerve analysis.

Orbital Inflammatory Disease as a Presenting Symptom of Generalized Lipodystrophy in a Young Female.

We report the first case of generalized lipodystrophy with orbital inflammatory symptoms. A 6-year-old female with hypothyroidism who developed hepatosplenomegaly, lymphadenopathy, and progressive loss of subcutaneous fat. Following flu vaccination, she developed orbital inflammatory symptoms. Imaging of the orbits demonstrated a paucity of retrobulbar fat and fat stranding. Systemic workup revealed insulin resistance and hepatosteatosis, consistent with generalized lipodystrophy. We discuss the typical history and examination findings in generalized lipodystrophy and review the etiology, treatment options, and outcomes.

Performance of ChatGPT in Ophthalmic Registration and Clinical Diagnosis: Cross-Sectional Study.

Artificial intelligence (AI) chatbots such as ChatGPT are expected to impact vision health care significantly. Their potential to optimize the consultation process and diagnostic capabilities across range of ophthalmic subspecialties have yet to be fully explored. This study aims to investigate the performance of AI chatbots in recommending ophthalmic outpatient registration and diagnosing eye diseases within clinical case profiles. This cross-sectional study used clinical cases from Chinese Standardized Resident Training-Ophthalmology (2nd Edition). For each case, 2 profiles were created: patient with history (Hx) and patient with history and examination (Hx+Ex). These profiles served as independent queries for GPT-3.5 and GPT-4.0 (accessed from March 5 to 18, 2024). Similarly, 3 ophthalmic residents were posed the same profiles in a questionnaire format. The accuracy of recommending ophthalmic subspecialty registration was primarily evaluated using Hx profiles. The accuracy of the top-ranked diagnosis and the accuracy of the diagnosis within the top 3 suggestions (do-not-miss diagnosis) were assessed using Hx+Ex profiles. The gold standard for judgment was the published, official diagnosis. Characteristics of incorrect diagnoses by ChatGPT were also analyzed. A total of 208 clinical profiles from 12 ophthalmic subspecialties were analyzed (104 Hx and 104 Hx+Ex profiles). For Hx profiles, GPT-3.5, GPT-4.0, and residents showed comparable accuracy in registration suggestions (66/104, 63.5%; 81/104, 77.9%; and 72/104, 69.2%, respectively; P=.07), with ocular trauma, retinal diseases, and strabismus and amblyopia achieving the top 3 accuracies. For Hx+Ex profiles, both GPT-4.0 and residents demonstrated higher diagnostic accuracy than GPT-3.5 (62/104, 59.6% and 63/104, 60.6% vs 41/104, 39.4%; P=.003 and P=.001, respectively). Accuracy for do-not-miss diagnoses also improved (79/104, 76% and 68/104, 65.4% vs 51/104, 49%; P<.001 and P=.02, respectively). The highest diagnostic accuracies were observed in glaucoma; lens diseases; and eyelid, lacrimal, and orbital diseases. GPT-4.0 recorded fewer incorrect top-3 diagnoses (25/42, 60% vs 53/63, 84%; P=.005) and more partially correct diagnoses (21/42, 50% vs 7/63 11%; P<.001) than GPT-3.5, while GPT-3.5 had more completely incorrect (27/63, 43% vs 7/42, 17%; P=.005) and less precise diagnoses (22/63, 35% vs 5/42, 12%; P=.009). GPT-3.5 and GPT-4.0 showed intermediate performance in recommending ophthalmic subspecialties for registration. While GPT-3.5 underperformed, GPT-4.0 approached and numerically surpassed residents in differential diagnosis. AI chatbots show promise in facilitating ophthalmic patient registration. However, their integration into diagnostic decision-making requires more validation.

Applications of Artificial Intelligence in Ophthalmology: Glaucoma, Cornea, and Oculoplastics.

Artificial intelligence (AI) is transforming ophthalmology by leveraging machine learning (ML) and deep learning (DL) techniques, particularly artificial neural networks (ANN) and convolutional neural networks (CNN)to mimic human brain functions and enhance accuracy through data exposure. These AI systems are particularly effective in analyzing ophthalmic images for early disease detection, improving diagnostic precision, streamlining clinical workflows, and ultimately enhancing patient outcomes. This study aims to explore the specific applications and impact of AI in the fields of glaucoma, corneal diseases, and oculoplastics. This study reviews current AI technologies in ophthalmology, examining the implementation of ML and DL techniques. It evaluates AI's role in early disease detection, diagnostic accuracy, clinical workflow enhancement, and patient outcomes. AI has significantly advanced the early detection and management of various ocular conditions. In glaucoma, AI systems provide standardized, rapid identification of disease characteristics, reducing intra- and interobserver bias and workload. For corneal diseases, AI tools enhance diagnostic methods for conditions such as keratitis and keratoconus, improving early detection and treatment planning. In oculoplastics, AI assists in the diagnosis and monitoring of eyelid and orbital diseases, facilitating precise surgical planning and postoperative management. The integration of AI in ophthalmology has revolutionized eye care by enhancing diagnostic precision, streamlining clinical workflows, and improving patient outcomes. As AI technologies continue to evolve, their applications in ophthalmology are expected to expand, offering innovative solutions for the diagnosis, monitoring, treatment, and surgical outcomes of various eye conditions.