Primary blepharospasm (PBS) is a form of focal dystonia characterized by involuntary, intermittent, or sustained contractions of the orbicularis oculi and periorbital muscles, resulting in involuntary eyelid closure. In clinical practice, PBS has received insufficient attention, and ophthalmologists often have limited experience in its diagnosis and treatment. Its early symptoms can be easily confused with other conditions, such as dry eye disease, leading to misdiagnosis and missed diagnosis, which delays treatment. As PBS is a progressive disorder, it may extend to adjacent regions, increasing treatment difficulty and negatively affecting patients' quality of life. Currently, there is no curative treatment for PBS, and standardized approaches for symptomatic relief remain lacking. To improve the clinical diagnosis and treatment of PBS, the Ophthalmic and Visual Science Committee of the Chinese Research Hospital Association convened experts from relevant specialties. Based on a comprehensive review and assessment of relevant literature from both domestic and international sources, and following standardized methodologies for guideline and consensus development, the panel formulated consensus-based recommendations addressing 11 clinical questions related to the diagnosis and treatment of PBS. These recommendations are intended to serve as a reference for Chinese ophthalmologists and healthcare professionals involved in the PBS-related health management.

The composition and volume of tear fluid lining the ocular surface are governed by the rates of lacrimal gland secretion, tear film evaporation, nasolacrimal drainage, and epithelial ion and water transport. Tear fluid hyperosmolality and reduced volume are key drivers of dry eye disease (DED) pathogenesis. We constructed a mathematical model to compute the composition and volume of tear fluid and epithelial cell compartments, with transport parameters specified for the mouse eye based on published data and in vivo measurements of ocular surface potential differences. The model accounted for transcellular and paracellular transport across the epithelia under open-circuit conditions utilizing flux equations for individual transport mechanisms, with mass balance constraints on solute and water content in cytoplasm and tear fluid. Model computations revealed a rough orthogonality between the determinants of tear fluid volume and osmolality in which lacrimal secretion and nasolacrimal drainage primarily regulate tear fluid volume, whereas evaporation and transepithelial osmosis primarily regulate tear fluid osmolality. Under DED conditions established by reduced lacrimal secretion and increased evaporation, the model predicted the efficacy of currently available DED therapies, including punctal plugs, humidification goggles, lacrimal gland stimulation, and artificial tear eye drops. The model also predicted the limited efficacy of anti-absorptive and pro-secretory drugs targeting epithelial ion transporters and the high efficacy of targeting epithelial water permeability or paracellular ion permeability. The modeling herein provided quantitative predictions to prioritize drug targets for DED to drive the development of novel therapies.

Extreme temperature potentially triggers eye disease in children: a multicity hospital-based study in China.

To highlight the overlooked role of ocular surface disease (OSD) in glaucoma, explore its pathophysiological links to treatment, and propose integrated strategies to improve patient care. A narrative review of current literature on the relationship between glaucoma therapies and ocular surface health was conducted. Evidence on prevalence, mechanisms, diagnostic approaches, and management strategies for OSD in glaucoma patients was reviewed. Glaucoma remains the leading cause of irreversible blindness worldwide, with treatment adherence being a critical determinant of long-term outcomes. Chronic use of topical intraocular pressure (IOP)-lowering eye drops, particularly those containing benzalkonium chloride (BAK), induces epithelial and goblet cell toxicity, tear film instability, and ocular inflammation. The prevalence of OSD in glaucoma patients is markedly higher than in the general population, affecting up to 60%. Symptoms such as dryness, burning, and blurred vision significantly reduce quality of life and compromise adherence to treatment. Emerging alternatives, including preservative-free formulations, selective laser trabeculoplasty, and minimally invasive glaucoma surgery, provide opportunities to reduce ocular surface burden. Structured evaluation using questionnaires, slit-lamp examination, and diagnostic tests can facilitate early detection and tailored management. The ocular surface, long considered secondary in glaucoma care, is central to optimizing both adherence and visual outcomes. Protecting ocular surface health through preservative-sparing regimens, procedural interventions, and patient-centered strategies is essential. Reframing OSD as an integral component of glaucoma management may improve long-term quality of life and enhance treatment success.

Small-molecule discovery and drug development are increasingly being pursued in academic settings, expanding beyond their traditional confinement to the pharmaceutical industry. The initial steps in drug discovery typically include identification and validation of a target, screening of chemical libraries to identify modulators of target activity, and subsequent prioritization and optimization of lead compounds using in vitro systems and animal models, with emphasis on compound potency, selectivity, and pharmacological properties. This review focuses on early-stage discovery of small molecules that target plasma membrane transporters on epithelial cells, including absorptive and secretory epithelia in kidney, gastrointestinal tract, lung, and eye. Of the estimated 500 distinct epithelial plasma membrane transporters, fewer than a dozen are the targets of approved drugs, most of which have been in clinical use for decades. We discuss the logistics and challenges associated with small-molecule discovery in an academic setting. Specific epithelial cell targets are considered, including chloride channels, solute-coupled transporters, urea transporters, and aquaporins, with therapeutic implications spanning constipation and secretory diarrheas, cystic fibrosis, dry eye disease, edema, hypertension, and kidney stones. We conclude by identifying unmet needs and outlining opportunities to enable next-generation pharmacological modulation of epithelial transport processes.

Quantifying Orbital Segmentation in Thyroid Eye Disease- Fat to Muscle Ratio Correlates With Restrictive Strabismus.

Rare eye diseases of the cornea and ocular surface (REDs) remain a clinical challenge owing to their low prevalence, heterogeneous presentation, and limited therapeutic options. As REDs mechanisms are often complex, preclinical models are essential to advance mechanistic understanding and support the development of targeted treatments. This review provides a comprehensive overview of the experimental platforms currently available to study REDs, including in vitro models such as primary and engineered cell systems, coculture approaches, and emerging 3D organoid technologies. In addition, we summarize in vivo strategies ranging from surgically induced models to genetic and transgenic systems that reproduce the relevant ocular phenotypes. By comparing the strengths, limitations, and translational value of these complementary approaches, this review offers an integrated perspective on how preclinical modeling can be optimized to investigate REDs pathophysiology. Furthermore, we highlight how emerging tools-such as organ-on-chip platforms and artificial intelligence-assisted analytics-may enhance model fidelity and accelerate the identification of effective therapeutic strategies.

Lifitegrast ophthalmic solution 5.0% (KH732) for dry eye disease: A randomized, multicenter, double-masked, vehicle-controlled phase 3 trial.

Immunomodulatory effects and clinical application of galectins in ocular surface.

Puerarin exerts a protective effect by alleviating the inflammatory response through inhibition of the NF-κB signaling pathway in a rat model of glaucoma.

Psychometric evaluation of the SPEED questionnaire: Factor structure and measurement invariance across contact lens wearers and non-wearers, sex and age.

Age-related dry eye disease: Redefining a distinct subtype driven by aging.

Thyroid eye disease (TED) can be visually debilitating and cosmetically disfiguring. Symptoms vary in severity and can lead to drastically impaired quality of life (QoL), ability to work, and mental health. The ElevaTED survey was developed to characterize impacts of TED on QoL, mental health, activities of daily living, sleep, work, and treatment experience. ElevaTED was conducted in July and August 2024. Participants included adult, US residents, with self-reported physician diagnosis of TED and symptoms that negatively impact daily life. Among 204 participants who completed the survey, mean age was 50years (30 to 82) and 74% female. Most (93%) reported experiencing symptoms of TED within the prior month of survey participation, 23% categorized their symptoms as "mild" in severity, 58% "moderate", and 18% "severe." Mean number of symptoms experienced was 6 at any time and 3 in the past month, with the most common symptoms reported being "red, swollen, or burning eyes" and "pressure or pain around or behind the eyes." The majority (72%) of participants indicated their TED symptoms had a "moderate" or "major" impact on their daily life over the prior month. Negative impacts were reported in QoL, sleep, depression, anxiety, and work, across symptom severity groups. Over 80% are worried about their symptoms returning/worsening regardless of treatments and most want to discuss QoL/impacts with their physicians. The results of ElevaTED highlight the impact that TED has on daily activities and mental health and underscore the need for more in-depth physician-patient dialogue beyond the visible signs and symptoms.

Diabetic retinopathy (DR) stands as a common microvascular issue associated with diabetes mellitus, a condition defined by progressive structural decline in the retina. Although studies have reported that vitexin exhibits positive pharmacological activity in inflammatory eye diseases and has been shown to protect against neuronal damage, its efficacy in treating DR and its underlying mechanism of action remain unreported. Cellular viability was determined via the Cell Counting Kit-8 (CCK-8) approach. Oxidative stress, apoptosis, and inflammatory response in cells were assessed via flow cytometry, the thiobarbituric acid (TBA) assay, commercial kits, and western blot analysis. Combined with bioinformatics analysis (online Swiss Target Prediction, Comparative Toxicogenomics Database (CTD), online Gene Cards, and molecular docking), it was confirmed that vitexin's cytoprotection in ARPE-19 cells against damage is mediated by caspase-3 (CASP3). In HG-challenged ARPE-19 cells, vitexin successfully mitigated oxidative stress. This was evidenced by downregulated levels of malondialdehyde (MDA) and reactive oxygen species (ROS), coupled with enhanced enzymatic performance of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px). It also attenuated the inflammatory response by suppressing tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) while promoting interleukin-10 (IL-10), ultimately leading to reduced apoptosis. Differential gene screening and molecular docking analysis revealed an interaction between CASP3 and vitexin. Moreover, in HG challenged ARPE-19 cells, overexpressing CASP3 significantly compromised the protective benefits conferred by vitexin. Vitexin alleviates damage to ARPE-19 cells induced by HG via CASP3, exerting a protective effect in early DR.

A 3-year multicenter trial was conducted to examine safety/tolerability and potential symptom relief delays following ocular sign improvement in patients with dry eye disease (DED) and severe keratitis using once-daily ciclosporin A (CsA) 0.1% cationic emulsion (CE). Adult patients with DED and corneal fluorescein staining (CFS) graded ≥ 3 (modified Oxford scale) received open-label CsA 0.1% CE for 12months. Patients achieving ≥ 2-grade CFS reduction at month 12 were randomized 3:2 to CsA 0.1% CE or vehicle during months 12-36. Incidence and onset of ocular surface complications and adverse events (AEs) were reported. Spearman's correlation coefficient (SCC) calculations examined any relationship between CFS and symptom assessment in dry eye (SANDE) changes. Overall, 336 participants received open-label CsA 0.1% CE. Mean (standard deviation) age was 59.4 (13.4) years and the majority were female (86.0%) and white (94.6%). In total, 279 (83%) demonstrated ≥ 2-grade CFS reductions and 245 were randomized at month 12. Ocular complications (infections; 3-6-line visual acuity reduction) occurred in 3.2% (n = 11;CsA 0.1% CE; open-label period), 4.7% (n = 7;CsA 0.1% CE; randomized period), and 3.1% (n = 3;vehicle). Median onset was 5.9 (open-label period), 8.2 (CsA 0.1% CE; randomized period), and 6.3months (vehicle). SCC values comparing month 3 CFS change with SANDE reductions at months 3, 6, 9, and 12 were 0.169, 0.245, 0.274, and 0.178, respectively, and indicated a 3-6-month delay in symptom improvement. Non-serious ocular treatment-related AEs occurred in 62 open-label participants and in 5 (CsA 0.1% CE) and 4 (vehicle) randomized patients. Once-daily CsA 0.1% CE was well tolerated with low ocular surface complication rates through month 36 in adults with DED. Symptom relief may be delayed by 3-6months following CFS improvement. NCT04144413; EudraCT Number: 2017-002660-41.

This guideline summarizes diagnostic and therapeutic approaches based on a systematic literature review and evidence evaluation using the GRADE methodology. Given the limited high-quality data, expert consensus was additionally obtained through a modified Delphi process. Remethylation disorders are rare inherited conditions that disrupt the methionine-homocysteine cycle and consecutively impair essential methylation dependent metabolic pathways. Remethylation disorders are caused by defects in the cobalamin or folate metabolism. The disorders typically result in elevated homocysteine and often low methionine; combined cobalamin-related defects also affect mitochondrial methylmalonic acid clearance. The cblC-MMACHC defect is the most common cobalamin-related remethylation disorder. Early-onset patients usually present with severe neurological and eye symptoms. Late-onset cases show variable symptoms (e.g., psychiatric, renal, thromboembolic events). Plasma total homocysteine, methionine, methylmalonic acid, serum vitamin B12 (and folates) should be assessed in suspected cases. Early detection through newborn screening is associated with improved clinical outcomes. Betaine as first-line therapy for methylenetetrahydrofolate reductase deficiency and parenteral hydroxocobalamin for cobalamin-related defects have reduced mortality and morbidity. Total homocysteine, methionine (and methylmalonic acid) should be kept as close to normal values as achievable. Emerging evidence suggests that early use of high-dose hydroxocobalamin (> 0.35 mg/kg/day) may improve neurocognitive impairment and may ameliorate eye disease in severe cobalamin-related defects. A major limitation in current practice is the lack of availability of high concentration hydroxocobalamin formulations for parenteral administration.

Deep learning based eye disease classification using Optical Coherence Tomography (OCT) images.

Tear fluid multi-omics and biosensor integration for diagnosis and personalized therapeutics in dry eye disease.

Recent advances in dry eye disease: Pathophysiology, diagnostics, and innovative drug delivery approaches

Intrinsic regeneration mechanisms of murine lacrimal gland epithelial cells for therapeutic applications in aqueous-deficient dry eye disease.